Medical treatment

Private hospitals will stop providing medical care under MEDISEP

Kozhikode: Private hospitals must stop providing medical care under the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP), citing the delay in settling the claimed amount and paying only one minimum amount.

Some hospitals have started notifying the government that they are having practical difficulties continuing the program. Even hospitals that have linked up with MEDISEP have reduced the areas of treatment covered by the scheme.

While you can get treatment in orthopedic, cardiology and general medicine departments, childbirth is not covered by most hospitals. Some hospitals that had allowed “delivery” under the program insist that it is only covered for two deliveries. Strangely, claims forwarded by hospitals were dismissed, citing that if the children from the first two deliveries are alive, the third delivery will not be covered by the scheme.

As MEDISEP was hastily set up, many hospitals still lack clarity regarding the procedure. The insurance company reimburses only the amount of the prefixed lump sum for each illness or treatment, at the hospital. As a result, altercations between patients and hospital authorities have become commonplace.

Complaints galore; not getting appropriate answers: hospital authorities

The amount claimed – the actual amounts spent on the particular treatment – is being reduced and paid, hospital authorities complain. Reimbursement of the final approved amount is also delayed.

In accordance with the agreement, the reimbursement will be credited to the hospital’s account within 15 days of the patient’s discharge. However, some hospitals have not even received reimbursement of Rs 1 even after a month and a half since the rollout of the scheme.

Although it was previously said that the room rate, surgery fee and implant cost can be claimed individually, now it is said that it is all part of the package price. Hospitals have to bear the brunt of it. Calls are not answered on the phone numbers provided to make such complaints. Hospitals have also complained about the lack of clear answers from oversight agencies.

Nodal agencies dealing with MEDISEP have indicated that technical complaints about the program are being addressed and resolved. Every detail is clearly mentioned in the agreement on MEDISEP. Hospitals are shouting aloud without clearly understanding the terms.

Authorities say the reimbursement process has started for many hospitals. There are reportedly technical issues with bank accounts, which may explain why some are not receiving refunds, authorities said.