By Our Reporter
SHILLONG, Sep 2: In a major setback for over 20 lakh people in Meghalaya, private hospitals in the city have refused to sign a fresh memorandum of understanding (MoU) with the Health department for implementation of Phase VII of the Megha Health Insurance Scheme (MHIS) citing non-payment of outstanding dues.
The Phase VI of the MHIS ended on August 31 and all private hospitals have to sign an MoU with the Health department for implementation of the next phase.
Highly-placed sources told The Shillong Times on Monday that the private hospitals in the city are reluctant to sign the fresh MoU since the state government has failed to release the dues which have accumulated since Phase IV of MHIS.
According to the sources, the pending dues for each private hospital is estimated to be more than Rs 3 crore although the final tally has not been officially disclosed.
Sources revealed that the management of all the city hospitals has jointly submitted a representation to Chief Minister Conrad K Sangma on Monday.
It has been informed that the representative of the various city hospitals had a virtual meeting with the State Level Executive Officer (SLEO) of MHIS, Ram Kumar on Monday.
Sources informed that the meeting was inconclusive since the SLEO did not give any assurance on the release of the pending dues.
The city private hospitals are likely to have a joint meeting on Tuesday to deliberate on the matter and to take a call on their future course of action.
Meanwhile, he sources said that the private hospitals were forced to take the drastic step as the state government had failed to release the pending dues despite several reminders.
“We understand that the patients are going to suffer owing to this decision but we are left with no other option since the management needs funds to run the hospitals,” a representative of a private hospital told The Shillong Times on the condition of anonymity.
He said that the state government should resolve this matter at the earliest since people belonging to the BPL category will be badly affected by this decision.
Details of the letter addressed to the CM
In their letter addressed to the chief minister, the private hospitals jointly mentioned their grievances with regards to unscrupulous and erroneous rejection of their MHIS claims.
They pointed out that they had received an email on March 10 this year regarding implementation of the Transaction Management System (TMS) 2.0 with an instruction that as the software is entirely new, hospitals may encounter operational challenges.
In this regard, the State Nodal Officer (SNA) requested the hospitals to continue serving the patient via Business Community Plan (BCP) mode and not deny benefits of the scheme.
“The insurance provider will consider all genuine cases encountered during this transition period, provided the hospitals inform the insurance company/SNA. As a consequence to the requests, benefits were extended as instructed. However, these claims are being rejected for reasons best known to them,” the hospitals stated.
According to them, most of their claims are being partially cleared without proper justifications from the insurance company despite uploading necessary medical documents on the TMS portal.
“With the implementation of TMS 2.0, we are unable to solve erroneous claims is since we are not able to upload the documents in the portal and this has led to more pending amount in the instance end,” the private hospitals stated.
The letter also mentions the pending dues pertaining to MHIS IV and MHIS V. “As you are aware that we are self-sustaining hospitals and we are facing a lot of financial constraints with all our pending dues not yet settled,” the private hospitals stated in the letter.
They also brought to the notice of the CM the cashless benefits extended to Accredited Social Health Activists (ASHAs), anganwadi workers (ANS) and helpers under the Pradhan Mantri Jan Arogya Yojana.
“Under SECC & NFSA, 90% of the patients admitted go for cashless treatment that economically impacts non-government hospitals which have the obligations to meet the expenses for salaries, equipment, maintenance and others on their own,” they stated.
Unless the difficulties encountered shown above are redressed, the letter stated that it will be difficult for the hospitals to sustain and join hands with the Health department for the next policy period, if extended.
A representative of a private hospital pointed out that for many patients under BPL, SECC, ASHA, RSBY, and NFSA, the hospital has to treat all of them without taking any money. However, the insurance company pays only whatever is mentioned for the particular package.
“Any excess expense required for treatment of a patient beyond the package has to be borne by the hospitals. This means private hospitals are paying for treatment of poor people. Now with delay/non-payment of funds, how will private hospitals sustain themselves,” the representative stated.