GIPSA stayed on Ophthalmological Society petition: Delhi HC directs cashless service to all hospitals

Putting an end to a system where the companies and TPAs insisted that a hospital had to be registered with them, the court in its interim order ruled that insurance companies will give empanelment to all healthcare providers duly registered with respective state authorities for cashless facility.

New Delhi: Breaking the alleged cartel of public sector general insurance companies when it comes to mediclaim treatment, the Delhi High court has recently ruled that insurance companies would have to honour cashless mediclaim(s) for policyholders who are treated at any healthcare establishments registered with Government.

This major relief for patients after the court’s decision comes in wake of a campaigning lead by Delhi Ophthalmological Society together with All India Ophthalmological Society.

Putting an end to a system where the companies and TPAs insisted that a hospital had to be registered with them, the court in its interim order ruled that insurance companies will give empanelment to all healthcare providers duly registered with respective state authorities for cashless facility.

Further, as updated by the representative, the court held, "the terms and conditions of the insurance policy to be followed for the patients to get the benefits as per the terms and conditions of their policies and the duly registered healthcare providers, even if their name is not on the list for cashless facility, can avail the same on all India basis."

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The move dents the functioning of General Insurance Public Sector Association (GIPSA), group of public sector insurance companies formed in 2011 which till now was only honouring cashless claims with empanelled hospitals.

However, this was objected to by the association of ophthalmologists in Delhi High court who alleged GIPSA of acting like a CARTEL and failing to observe transparency in the empanelment process.

Speaking to Medical Dialogues, Dr Chander Prakash Khandelwal, Member, TPA SubCommittee, Delhi Ophthalmological Society called GIPSA an alleged cartel and being corrupt, non-transparent and arbitrary in its working by using all available avenues.

“ I filed complaints with IRDA, concerned officer & even PMO. I even used Tweeter but of no avail,” said Dr Khandelwal.

With the rising issue, the association approached these public sector general insurance companies, that were constituents of, however, the companies did not acknowledge the concern. Subsequently, the body sought legal remedies, thereby, filing a PIL in the Delhi High Court, he informed.

It was contended that the General Insurance Public Sector Association (GIPSA), a group of public sector insurance companies formed in 2011 has failed to observe transparency in the empanelment process.

Moreover, negligible empanelment has been entertained in Delhi while the agents or third-party administrators (TPAs) demands an extraordinary amount of money for empanelment.

Dr Khandelwal further alleged that GIPSA is not a legal entity but a group of insurance companies unnoticed by Insurance Regulatory and Development Authority (IRDA).

“We filed RTIs asking IRDA regarding GIPSA and its legality. However, IRDA regulator mentioned that they have no information about the same,” said Dr Khandelwal.

The order, an interim ruling, was passed by a bench of then, Chief Justice Rajendra Menon and Justice Brijesh Sethi on May 31.

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, reports TOI.

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