The city of Ahmedabad has become a battleground in the ongoing conflict between healthcare insurers and hospitals, reigniting concerns that had somewhat abated during the COVID-19 pandemic. The Ahmedabad Hospitals and Nursing Homes Association (AHNA) has issued a stern ultimatum to standalone health insurer Star Health and Allied Insurance, threatening to withdraw the cashless facility unless critical issues are promptly addressed.
Star Health’s Chief Financial Officer, Nilesh Kambli, expressed the insurer’s commitment to resolving the dispute amicably. He emphasized the company’s dedication to safeguarding its customers’ interests and anticipated a constructive resolution during a second round of discussions scheduled for October.
The insurer claims to have suspended relationships with approximately 500 hospitals out of its 15,000 affiliates over the past two years due to non-compliance with medical protocols and instances of fraud. Reasons for suspension include hospitals not adhering to tariff rates, excessive antibiotic use, unnecessary lab testing, overbilling by doctors, and cases of misrepresentation and fraud.
The AHNA, representing a consortium of hospitals and nursing homes in Ahmedabad, has set a firm deadline of October 15 for Star Health and Allied Insurance to address key concerns. These issues encompass a high rate of claim rejections post-approval, lengthy payment clearance delays, unsustainable charges set by insurers, and the removal of hospitals from the insurer’s networks.
This dispute underscores the ongoing tension between healthcare providers and insurers, with both parties seeking to protect their interests while ensuring access to quality healthcare for patients. Resolving these issues will be crucial to maintaining a functioning healthcare ecosystem in Ahmedabad and addressing the concerns of both hospitals and insurers.
