The General Insurance Council on Tuesday hit back at the Association of Healthcare Providers (India) (AHPI) over its decision to suspend cashless treatment facilities for certain general insurers. The council said AHPI’s unilateral action was “arbitrary, lacking clarity or actionable details”.
In a strongly-worded statement, the council slammed AHPI’s intent to suspend cashless hospitalisation for customers of Bajaj Allianz General Insurance and Care Health Insurance from September 1.
Bajaj Allianz General Insurance is scheduled to meet AHPI on Wednesday to discuss revocation of the suspension.
Hospitals Cite Low Tariffs and Delayed Payments
On Monday, the AHPI advised its 15,000 member hospitals to suspend cashless treatment for Bajaj Allianz and Care Health policyholders in North India from September 1. The decision follows complaints from hospitals regarding low reimbursement rates, unilateral payment deductions, delays in claim settlements, and extended approval timelines for pre-authorisation and discharge requests.
The AHPI, whose members include Max Healthcare and Medanta, said Bajaj Allianz has not revised reimbursement tariffs despite rising medical costs, making continued treatment at outdated rates financially unsustainable.
However, Bajaj Allianz refuted AHPI’s allegations. “No undue pressure will buckle us down, none of our customers will suffer. As of now, we have not received a single case of denial of cashless, but even if we do, we shall ensure that our customer gets the money in his/her account before they have to pay the hospital,” said Tapan Singhel, MD & CEO, Bajaj Allianz General Insurance.
Council Warns of Risk to Patients in Emergencies
The General Insurance Council said AHPI’s sudden action has created confusion and concerns among citizens, impacting trust in the health insurance ecosystem. “Instead of enabling dialogue and resolution, a press statement was abruptly issued, prejudicing the interests of policyholders across the country,” it said.
The council highlighted industry initiatives like Cashless Everywhere and the National Health Claims Exchange, which allow patients to access treatment without upfront payments. Insurers have heavily invested in these reforms, supporting crores of health insurance enrolments and settling over ₹87,000 crore in claims during 2023-24.
“Disruption in cashless service not just directly impacts families through higher upfront spends on treatments and out-of-pocket expenses, it also threatens survival of patients in critical medical conditions requiring immediate medical attention,” the council said.
It added that AHPI’s action “undermines the sanctity of a human life, especially in cases requiring emergency hospitalisation”, where a policyholder should not be denied cashless treatment, and be forced to make financial arrangements.
The council has urged the AHPI to immediately withdraw its advice and engage constructively with insurers by continuing cashless services for all health policyholders.