Published in Livemint.
Max Healthcare has de-empanelled Max Bupa Health Insurance Co. Ltd from its chain of hospitals, leaving policyholders in a fix as they will not be able to avail the cashless claims facility.
Max Bupa is a joint venture between True North, an Indian private equity firm and UK-based healthcare services firm Bupa. Max Healthcare is the amalgamation of erstwhile Max India into Max Healthcare and demerger of the healthcare business of Radiant Life into Max Healthcare.
Insurance experts we spoke with said that this isn’t the first time something like this has happened but it’s not very often that a healthcare provider de-empanels an insurer. In most cases, it’s the insurer that eliminates healthcare providers from its network if it finds the partnership unsustainable.
A Max Bupa spokesperson said the insurer is currently in discussion with Max hospitals on revised tariff plans and that this is a routine exercise. “Temporarily our customers will not be able to avail the cashless facility at Max hospitals. To support our customers and help them cope with the situation, we have started the process of instant reimbursement in which admissible claims are paid within two hours,” said the spokesperson to Mint.
An expert who spoke to Mint, on the condition of anonymity, said that large-scale de-empanelment like in this case, does not happen frequently unless there is an issue with the insurer clearing the outstanding dues of the hospital or not agreeing to the revised rates.
“The contract between Max Healthcare and Max Bupa had expired in May 2019. Max Healthcare has been in discussion with Max Bupa for a fresh contract for the last 15 months and has been extending cashless services to its beneficiaries over all these months even though there hasn’t been a valid contract. In spite of our best efforts, the contract couldn’t be closed to the satisfaction of both the parties and, hence, Max Healthcare has been left with no choice but to suspend cashless services for Max Bupa customers,” said a Max Healthcare spokesperson.
Abhishek Bondia, managing director and principal officer, SecureNow.in, said in the past, a similar instance did come up where all the public sector insurers delisted a number of large hospital chains because there was a strong disagreement on the General Insurance Public Sector Association rates. “This was the insurers de-empanelling the hospitals but it took a few months to get resolved. It’s incumbent on both hospitals and insurers to resolve the issue smoothly because the hospitals may lose patients and confidence in the insurer may go down too if some policyholders prefer getting treated at a specific hospital,” said Bondia.
Mahavir Chopra, founder, Beshak.org, an independent research platform for retail buyers, said insurers are more dependent on hospitals and would want all major hospital chains to offer the cashless claims facility. “The negotiating power of an insurer isn’t too much because policyholders decide based on the doctor and the hospital and then check whether the cashless treatment option is available or not. Therefore, if insurers don’t agree to the rates or don’t clear the dues on time, then the hospital may not shy away from delisting the insurer.”
The Max Bupa spokesperson said customers would be able to avail the cashless claims facility at Max hospitals within a couple of weeks.