It promises to be a long drawn battle, with no quick victory for either side. As a clutch of medical societies in Mumbai come together to face the four giant insurance companies and the Third Party Administrators (TPA), the latter are digging in their heels, unwilling to compromise on most of the issues.

In the last fortnight, at a series of meetings held jointly by Association of Medical Consultants, Indian Medical Association, Bombay Nursing Homes Association and Association of Hospitals, one thing was clear. The much-vaunted 'cashless' service will not gain acceptance from the medical fraternity, unless the insurance companies make substantial changes in their agreements with the nursing homes and hospitals.

This is because many leading consultants had their own horror stories to tell. One of the hardest hit seems to be Dr Paras Punamiya, who had faced numerous difficulties in getting his payments, not once but several times.

For one of his patients, who had come for an MRI, the Medicare Services Pvt. Ltd could not issue a simple authorization letter for over a week. The doctor himself had to pay the bill, while the patient is clearing the amount in tiny installments every month. He also had to wait for nearly two years to receive a payment of Rs 1.5 lakh from TTK Healthcare. Similarly, Dr Parvez Sheikh, secretary Bombay Nursing Homes Association, had to wait nearly two months before he could get one of the registered TPAs to cough up Rs 40,000.

"There have been numerous complaints from members and owners of nursing homes about the lapses on part of the TPA. Most common among them is their inability to reimburse the (nursing home) owners within a reasonable time," says Dr Sudha Sheth, president-elect, Association of Medical Consultants and President, Bombay Nursing Homes Association.

The big hospitals too have suffered in a similar fashion. The Holy Family Hospital, Bandra, has been running from pillar to post to get its Rs 2,61,000 reimbursed. Breach Candy Hospital has unrealized accruals of Rs 55 lakh and the M G M Hospital at Vashi, which has waited for more than four months for its dues of Rs 7 lakh to be cleared.

The TPAs don't deny that payments are being delayed. Dr Nayan Shah, Managing Director, Paramount Healthcare, says "From payment delays ranging to at least four-months, we have now managed to downsize it to nearly a month. It won't be far when the whole cashless system would become an 'online' venture clearing claims in less than 15 days."

Even that is not enough, says the medical fraternity because the insurance companies have created a 'Float Fund Account' for each of the TPAs to enable them to clear the bills promptly. According to Mr S K Mahapatra, the secretary general of General Insurance (Public Sector) Association (GIPSA), this ranges from Rs 5 lakh to Rs 1 crore.

Hence the medical societies have decided to allow a maximum of one month for their bills to be cleared and charge a penal interest of 18 per cent on any outstandings after that time. If the TPAs and insurance companies do not agree to these terms, as well as a wide range of modifications to the current schemes, they will not entertain any insured persons on a cashless basis.

The doctors have other grievances, too. "The TPA's do not even bother to notify us when fixing rates and further go ahead implementing them without prior notice. They form policies without taking consultants into consideration when the bottom line is that it is being done for the sake of the consultants," says Dr Parvez Sheikh.

According to him, while registering there is a clause wherein the TPA's are eligible to cancel the registration of the consultant if they find any fault/lapse in service, but on our part we cannot do anything if we find any fault in their services, "How is this move justified?" questions Dr Sheikh.

But Mahapatra is unfazed by the welter of allegations against the system. When asked about the numerous complaints and allegations made by the doctors, he claimed that in most cases the medical community itself has to be blamed as they were not co-operative in sharing and disclosing data for the streamlining of TPA.