New Delhi: As health insurers struggle with issues related to inflated billing, the insurance and health committees of industry lobby Federation of Indian Chambers of Commerce and Industry (Ficci) are developing yardsticks to establish minimum standards of treatment and costs for some diseases.
These standards are expected to give some indicative lines to insurers for settling bills with hospitals. The committee has completed its benchmarking for cataract and asthma.
“Once guidelines are developed for all the diseases, it will help insurance companies in pricing their products, settlement of claim disputes and in packaging new kinds of products,” said Jyoti Viz, director of financial sector at Ficci.
When all the standards are available, the Insurance Regulatory and Development Authority will decide whether they should be made mandatory or left to the discretion of the companies, Viz added.
For the last six months, the committee has been developing these standards along with the regulator and the General Insurance Council, or GIC, an umbrella body of general insurers.
A senior official at a public general insurance company said some sort of arrangement with hospitals would be required to control costs through such protocols.
“The benchmarking can be successful only when underwriters commit that they will patronize only hospitals which accept these benchmarks for billing purposes. Apart from this, volumes generated by insurers from health insurance business need to increase manifold,” said Niraj Kumar, general manager of The Oriental Insurance Co. Ltd. “No standard has come to us so far.”
Cases against insurance companies, especially involving the health insurance segment, account for the highest number of cases in consumer courts.
After standards are available, Ficci will run them through medical associations to ensure their accuracy.
“We are in the process of developing protocols for a few more diseases so that variations in bills for the treatment of the same disease under similar conditions can go off,” said a senior GIC official, who asked not be named.
He added that these benchmarks can be used by health insurers as a reference and guidelines in speedy settlement of claims involving insurance companies, hospitals and consumers. “In future, insurance companies can come out with products which can link their sum assured to the standard treatment cost of certain diseases.”