The Association of Healthcare Providers of India (AHPI) on Thursday said it held discussions with Bajaj Allianz General Insurance Company to address mounting concerns of member hospitals following its recent advisory to suspend cashless services for the insurer’s policyholders.
The association’s core committee members and senior Bajaj Allianz representatives discussed several unresolved issues that are placing hospitals under “severe financial and operational stress.”, AHPI said in a statement.
Cause of conflict: Financial and operational strain
On Monday, AHPI had advised its over 15,000 member hospitals to suspend cashless treatment for Bajaj Allianz and Care Health policyholders in North India from September 1.
The move, AHPI said, was prompted by complaints over low reimbursement rates, unilateral payment deductions, delays in claim settlements, and extended approval timelines for pre-authorisation and discharge requests.
The General Insurance Council had criticised AHPI’s action, terming it “arbitrary, lacking clarity or actionable details.” AHPI, however, has maintained that Bajaj Allianz’s tariffs have not been revised for many years despite medical inflation and rising operating costs.
“We urge all the insurers to work in partnership with hospitals and immediately restore cashless services at member hospitals. They also need to engage with the member hospitals regularly to revise outdated rates, set up transparent grievance mechanisms, and respect clinical autonomy,” said Girdhar Gyani, director general of AHPI.
Broader industry concerns and regulatory intervention
AHPI added that it has urged insurers to restore cashless services at member hospitals, noting that patients are suffering and hospitals are facing irate customers unable to access treatment at their preferred facilities. The association indicated it would review its advisory once insurers resume cashless services over the next few days.AHPI represents around 15,200 hospitals across the country, including leading healthcare chains such as Max Healthcare and Medanta. Meanwhile, the Delhi Medical Association Nursing Home Forum (DMA NHF) has filed a formal complaint with the Insurance Regulatory and Development Authority of India (Irdai), alleging anti-competitive practices by health insurers acting collectively through the General Insurance Council (GIC).
DMA NHF urged Irdai to investigate the GIC’s role in cartelisation, examine the abuse of dominance by private insurers, direct corrective measures to ensure fair and inflation-adjusted hospital tariffs, safeguard patient rights by ensuring continuity of cashless services, and involve the Serious Fraud Investigation Office (SFIO) to examine insurers’ conduct against public interest. (with inputs from fe bureau in Pune)