Pune: The govt has directed hospitals to keep charges reasonable while also urging companies and healthcare facilities that the rate of insurance claim rejections be low. Maharashtra will soon become the first state in the country to take strict action if these directives for patient welfare are ignored.In a statement issued on Wednesday, the health department said complaints received by the Insurance Regulatory and Development Authority of India (IRDA) would be studied and remedial measures taken.The decisions were taken during a meeting on Wednesday attended by state health minister Prakashrao Abitkar, representatives of insurance companies and private hospitals as also officials of IRDA and the state health department.Abitkar told the insurance companies to regularly submit information about the number of admitted patients, approved and rejected claims and complaints received to the health department, basis which appropriate action would be taken.He said the govt’s priority was to increase the credibility of the medical profession and it was committed to ensure that no patient faced difficulties in availing treatment and claiming insurance.”It is essential to ensure that no injustice is done to common people, even though insurance companies and hospitals work professionally,” he said.“Medical insurance is an important issue. The number of hospitals and private insurance firms providing quality and updated services is increasing in big cities, like Mumbai and Pune. In view of the development of medical tourism in the state, the two professions should increase their credibility in business. It is necessary to keep the focus on patients,” he added.Abitkar underlined the need to set a fixed time limit for claim approval, even as he directed hospitals in the state to register on the IRDA portal and keep all information updated. “Patients often suffer mental and financial hardships due to lack of coordination between hospitals and insurance companies. The govt will take necessary decisions to ensure that patients get immediate treatment and the claim process becomes transparent and easy,” he added.Currently, about 8,000 hospitals in the state provide insurance services and the govt has received complaints of malpractices in certain facilities, said Abitkar. “I have instructed that in such cases, the department must take action as per the Bombay Nursing Act. It must be mandatory for large hospitals to display a tariff sheet explaining the rates of treatment.”During the meeting, the need to prepare a standard treatment protocol was raised regarding differing rates being charged by different hospitals for the same medical treatment. Abitkar also said the govt is contemplating to set up a common empanelment mechanism for insurance companies and hospitals.Health services commissioner Dr Kadambari Balkavade, health director Dr Nitin Ambadekar, joint director Dr Sunita Golhar and senior officials of the public health department were also present in the meeting.
