Insurance co’s dilly-dally in medical bill reimbursement
SHILLONG: Following several complaints regarding the delay in reimbursement medical bills to the empanelled hospitals for medical treatment under Health Insurance Scheme (MHIS), the Health Department has issued show-cause notice to the New India Assurance Co. Ltd to clear the mess.
An official source said that the Health Department had already sought explanation from the insurance company, which is supposed to reimburse the expenditure in time incurred by the hospitals which were empanelled by the government.
Earlier, a Tura-based hospitals refused to accept the health cards stating that the medical expenditure incurred for the beneficiaries, was not reimbursed by the Company.
When contacted, the West Garo Hills Deputy Commissioner Pravin Baskshi cited an example of Tura Christian Hospital whose dues are Rs 43 lakh which is yet to be reimbursed by New India Assurance Co. Ltd.
An official said that the state government signed one year agreement with New India Assurance Co. Ltd as it was the lowest bidder to implement the scheme.
As per the agreement, while the premium will be paid by the government, the India Assurance Co. Ltd was entrusted with the task of clearing re-imbursement to empanelled hospitals.
Earlier, in January, a statement issued to the media by New India Assurance Co. Ltd had said that the Company has till date paid Rs.8.11 crore to hospitals empanelled under the scheme since the inception of the policy with effect from August 1 last year.
The Company further said that there has been no announcement at any point of time that it will stop payment of claims to hospitals.
Though the scheme is originally under Rahstriya Swasthya Bima Yojana (RSBY) as per 90:10 pattern in terms of expenditure to be borne by both the Centre and the state, Meghalaya has covered various illnesses which were not under RSBY and christened it as Megha Health Insurance Scheme . The features of RSBY are also included in MHIS.
While a beneficiary has to pay only Rs 31 at the time of enrolment, the MHIS covers hospitalization expenses up to Rs 1,60,000 for a family of five on a floater basis which means that the total amount can be used by one person or jointly with other members of the family. A single beneficiary can avail a maximum of about Rs 1 lakh at one time.
