Association of Healthcare Providers India (AHPI) has stopped all cashless payments provided by private hospitals empanelled under the ESIC scheme from September 1, 2015. The move ensues after the central government failed to clear the outstanding dues of over Rs. 110 crore.

There are around 40 private hospitals in the state coming under the ESIC scheme which is offered to employees coming under the income slabs of less than Rs. 15,000. With the stopping of this cashless facility, the hospitals have begun to provide concessional rates in treatment and surgical inventions which now matches ESIC rate or offer discounts to support the patient pool coming under this category, Dr Alex Thomas, executive director, AHPI told Pharmabiz.

The Association had earlier indicated that under the cash payment process, patients could seek treatment from private healthcare providers on a concessional rate and have it reimbursed by the government later.

As of now the beneficiaries could avail the hospital services at concessional rates by paying cash and get it reimbursed by ESI later. The huge backlog of payments that need to be recovered has muddled the smooth functioning of critical care which include cardiac, dialysis, cancer and organ transplantation, which are among the frequent and common conditions seeking cashless treatment, said Dr Thomas.

According to the private healthcare providers, the irregular payments received from ESI have impacted the functioning of hospitals.

Despite continual interactions with the ESI officials and other senior government officials of the department which include Union minister for labour, Narendra Singh Tomar, among others, the issue was not sorted out and this led us to suspend cashless treatment, noted the Association.

Currently, there are no norms for speedy settlement of claims. With this move to stall all cashless payments, the member hospitals of AHPI have sought uniform guidelines to ensure faster disbursement of claims, along with a revision of costs in treatment, said Dr. Thomas.

Some of the claims have not been settled for the last 24 months and there are over 40 network hospitals including major players such as Manipal, Columbia Asia, Narayana Health, Ramaiah hospitals and HCG under the AHPI umbrella.

“The problem is a long drawn issue and we are unclear of the developments in the future. Therefore for now we are looking at this situation for a period of five months,” stated Dr. Thomas.

Another issue bogging down the private hospital sector was the absence of standardisation in cost of treatment and the amounts have been deducted at the time of reimbursement without any explanation, noted the Association in its recent meeting.