Kolkata doctors refuse cashless treatment due to low rates

Kolkata: A few doctors at private hospitals in Kolkata are refusing to treat patients covered by health insurance or government schemes because the reimbursement rates are lower than what they typically charge for cash-paying patients.

While some private hospitals have partnered with the government's cashless treatment scheme, certain mid-level or big private hospitals are unable to participate because the doctors are hesitant to accept insurance rates.

In some cases, the doctors were observed charging a higher price than the one specified in the package. Health insurers have reported receiving bills for reimbursement from hospitals and nursing homes, where the doctor's fee exceeds the package amount.

Officials of several big private hospitals admitted that some senior doctors refuse to treat patients who have health insurance or are beneficiaries of government schemes such as the West Bengal Health Scheme or Swasthya Sathi.

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The Cashless Everywhere scheme launched by the General Insurance Council in January enables any medical insurance policyholder to access cashless facilities for treatment in any hospital, even if that hospital is not on their insurance company's network.

However, it is to be noted that when hospitals and insurers fail to agree on treatment costs, cashless services cannot be offered.

Speaking to the Telegraph, Saurav Kariwala, deputy manager, National Insurance Company Ltd, and member, Kolkata Preferred Provider Network Committee said, “Since the launch of the ‘Cashless Everywhere’ initiative, many smaller hospitals and nursing homes have applied for tie-ups for cashless treatment. Several of these hospitals are in the process of finalising the tie-up.

However, some hospitals are not tying up because they said the doctors are resisting on the ground that insurance package rates are lower than those billed for patients paying by cash. Because of that, these few healthcare units are not being able to tie up for the cashless facility."

“Recently, in one such case, the nursing home had included the doctor’s fee in the final bill. The amount charged by the doctor was much higher than what was agreed on with the hospital as part of the package. When we intervened, the nursing home refunded about Rs 70,000 to the patient who had already paid,” he said.

“Many senior doctors refuse to treat patients under various government schemes because the rates are so low that they are often not viable for the doctor as well as the hospital. In those cases, we offer services of qualified but not so established junior doctors,” said Rupak Barua, president, Association of Hospitals of Eastern India.

“As for PPN, the consortium of insurers is supposed to revise the rates every two years. But often the rates remain the same for even up to four years. And the rates are so low that they are unviable. The cost of infrastructure and overheads is increasing fast. So, many doctors refuse to take patients under such PPN schemes. However, it is our constant endeavour to accommodate all patients and refuse no one,” he added.

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