Bombay HC seeks details of hospitals accepting cashless mediclaim The Bombay high court on Thursday directed the General Insurance Council (GIC) and Association of Third Party Administrators (ATPA) to submit details of number of hospitals, nursing homes and clinics which have accepted cashless mediclaim policy. GIC represents 25 non-life insurance firms, ATPA represents 22 TPAs which act as intermediaries between hospitals, insurers and consumers. A division bench of Chief Justice Mohit Shah and Justice B P Colabawalla heard a PIL by activist Gaurang Damani, highlighting problems faced by consumers after cashless facility was stopped and lack of transparency in claim settlement. To a query by the judges on whether the number of hospitals offering cashless facility is on the rise, Damani replied that the figure may not be more than 200 in Mumbai. The judges also noted that hospitals associations were not present to give the actual figure. ATPAs advocate Birendra Saraf said that the existence of TPAs helps consumers although allegations have been made against them. The judges said that TPAs are alleged to be given incentives to reduce amount of claims. Damani said that while the TPAs job is to process claims, they settle claims and issue cheques. On April 21, the court directed the Insurance Regulatory Development Authority to conduct a study to discern if there was a pattern in TPAs not passing the entire amount claimed by policyholders. Adjourning the hearing, ATPA has been directed to assist IRDA in the study.
Posted on: Fri, 21 Nov 2014 07:40:23 +0000
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