The Delhi high court has ruled that insurance companies would have to honour claims by valid medical policy holders who have received treatment at any government-registered hospital. Cashless facilities must also be extended to all such hospitals. As reported by The Economic Times, the court thus has put an end to a system where health insurance companies and third-party administrators (TPAs) insisted that a hospital had to be registered with them for patients to avail of insurance claims. The insurers and TPAs also dictated which hospitals could extend cashless facility.
The order, an interim ruling, was passed by a bench of then Chief Justice Rajendra Menon and Justice Brijesh Sethi on May 31.
The HC held that all patients were entitled to medical insurance, including cashless facility, as long as they held a valid medical claim policy and that the General Insurance Public Sector Association (GIPSA) — group of public sector insurance companies — could not insist that hospitals must be registered with them.
Though the current order was limited to patients seeking eye treatment, the court found fault with the very basis of GIPSA’s guidelines and the external system of “network hospitals” to exclude government-registered hospitals. It may, therefore, be applied to other treatments as well.
HC further directed that “the benefit of providing cashless service be also extended to such medical health providers whose names may not be registered online with GIPSA but if they are registered with the respective state authorities as per law applicable to a particular state, the cashless service be extended even to these medical health providers/beneficiaries.”
The petitioners argued that these guidelines, compelling them to register with insurance and TPA networks, were illegal as the hospitals were already recognised by the state or central governments. They also blamed IRDA for ignoring the violations, arguing that “the influence of the insurance company and ‘TPA mafia’ within the healthcare system is so much that even IRDA is shying away from keeping regular checks on unauthorised working of these.”