Insurance Companies Violating Guidelines, Accused of Unfairly Rejecting Claims: AHPI
Introduction
The AHPI (Association of Healthcare Providers India) has raised serious concerns about the conduct of private insurance companies operating in the country. According to AHPI, insurance companies have been unjustly denying claims and blatantly disregarding IRDAI guidelines. Additionally, this collective of hospitals and healthcare providers argues that such behavior indicates the formation of an “alarming cartel” among private insurers.
Deprivation of Cashless Facilities and Patients’ Rights
The AHPI asserts that these insurance companies have collectively decided to discontinue cashless facilities provided to hospitals, resulting in the deprivation of patients’ right to choose their preferred treatment and healthcare providers. This arbitrary action places insured patients in an unfavorable position.
Plight of Insured Patients and Burden on Private Hospitals
The real victims in this scenario, according to the AHPI, are the insured patients. As their claims are unfairly denied, individuals find themselves in urgent need of funds to cover escalating medical expenses, particularly those in need of emergency care. Simultaneously, private hospitals are burdened with mounting costs and substantial losses due to the conduct of these insurance companies.
Resistance to AHPI’s Efforts and Escalating Complaints
Dr. Girdhar Gyani, the Director General of AHPI, reveals that the association’s attempts to rectify this situation have been met with resistance. Multiple complaints have been filed with IRDAI, yet tangible action is yet to be taken by the regulatory authority. Disturbingly, several members across the nation have reported similar harassment by insurance companies, prompting AHPI to take these concerns more seriously.
Considering Legal Action and Approaching the Competition Commission of India
Consequently, AHPI is contemplating legal action and plans to approach the Competition Commission of India to draw attention to these concerning practices. Dr. Gyani cites a distressing case where one of their member hospitals in Delhi was abruptly disassociated by a well-known insurance company. Shockingly, the insurer demanded substantial discounts from the previously agreed-upon rates, leading to the hospital’s removal from the network without providing a satisfactory justification.
Demanding Action Against Private Insurance Companies
AHPI demands swift action against private insurance companies that engage in such practices. The association believes that addressing these issues is crucial to safeguard the rights and well-being of insured patients in India.
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