Name hospitals not on cashless list, says CIC

MUMBAI: The Central Information Commission has ordered that public sector health insurance companies must provide names of hospitals that do not feature in the Preferred Provider Network (PPN) for cashless services to an applicant under the Right to Information Act.
The commission has also directed insurance companies to provide reasons for taking the hospitals off the list.
In the decision dated July 27, 2011, Information Commissioner Deepak Sandhu said this information needs to be disclosed as the person may have taken a medi-claim policy on the assumption that the cashless facility will be made available to him or her in all hospitals that feature on the list provided by the company.
Justifying the ruling, Sandhu reasoned that the insurance company’s obligation is not reduced in anyway in terms of the amount of premium required to be collected from the policy holder. Whereas, the insurance company, in a non-transparent fashion, reduced the facility that was available to the appellant (policy holder) at the point of taking the mediclaim policy by taking off some of the hospitals from their list of hospitals providing cashless facility.
“Therefore, it is the right of the appellant to know the names of the hospitals along with the reasons for taking them off the cashless facility list,’’ Sandhu said.
Chetan Kothari, an RTI activist, on whose application this order was passed, said, “A year ago, I had filed an application with the Public Information Office of the New Indian Assurance Company’s Tardeo branch. Instead of answering the query, the PIO erred by transferring my query before the first appellate authority and that too after a lapse of 30 days.
“The appellate authority directed the PIO to provide me with the information, but he did not conduct any hearing as laid down under RTI. Moreover, when the information was provided, it turned out to be incomplete,” he added.
Kothari then filed a second appeal before the CIC against the public sector insurance company for not provided names of hospitals. Taking strong exception, the CIC then ordered the insurance firm to take corrective measures.”
The four public sector insurance firms that came out with the PPN system in 2010 are: New Indian Assurance Company, Oriental Insurance Company, United Indian Insurance and National Insurance Company. Under the PPN, insurance companies have offered a fixed rate for 42 treatments that are covered under the cashless mediclaim policy.
The hospital joining the PPN will have to offer treatment to cashless mediclaim policy holder as per the rates fixed by the insurance company.