Black days for patients begun; private hospitals stopped admitting patients under PMJAY

208

Private hospitals to stop Ayushmaan work if govt fails to release payments-IMA Punjab-Photo courtesy-Internet — Private Hospital

Black days for patients begun; private hospitals stopped admitting patients under PMJAY

Kanwar Inder Singh/ royalpatiala.in

All PMJAY ( Sarbat Sehat Bima) empanelled hospitals of Punjab have stopped taking new patient after time line given 22-10-2021 expired yesterday. All the branches of Indian Medical association (IMA) have issued an advisory to its members to hold taking new patients till insurance company is holding your claims.

All PMJAY Empanelled hospitals are working hard with Government to pass on the benefits of your ambitious PMJAY Scheme to the poorest of the society who otherwise could not think of getting treated at quality private hospitals. But it is a very sorry state that all are disappointed the way Insurance companies are implementing the schemes.

It’s always a matter of concern that every insurance company does a bit of tit bits to minimize claim amounts but since SBI General Insurance Co. has joined the scheme on 20-08-2021 the things have taken the ugliest turn.

Since SBI Gen joined they have not released claim payments (As per guidelines it’s to be done in 15 days) on one pretext or Other viz. Non-working of ECH Mandate/ Non Signing of MOU ( Though they are authorizing case for treatment which itself means they are deemed to be in MOU) /CAG etc.

If we talk of reservation of packages in Punjab 194 packages are reserved whereas in nearby states of Rajasthan, Haryana & Himachal only 30-40 packages are reserved but in Punjab almost all packages of Gynae -Obstetrics and Ophthalmology are reserved so patients are bound to go to govt. Hospitals or have to spend their pockets if they want to go to private hospitals.

Black days for patients begun; private hospitals stopped admitting patients under PMJAY-Photo courtesy-Internet — Private Hospital

Black days for patients begun; private hospitals stopped admitting patients under PMJAY. Now to save their money the SBI General Insurance has started harassing and humiliating hospitals in many ways-
1.Delayed Authorisation ( Turn Around Time (TAT) 6hrs/2hrs) : Patient has to wait for 2 to 3 days for start of treatment which wastage of resources and manpower.
2.Delayed Claim Settlement (TAT 15 Days)
3. Unnecessary queries for claim settlement (Post Op USG after even HPR)
4. Harassment of Inspections by BAMS/BDS/BHMS : and Many of the Empanelled hospital have received Show cause notices and suspensions based on their reports which is violation of NHA Guidelines & Tender Documents.
As per NHA Guidelines and Tender Documents only MBBS or doctor with higher qualification is eligible to do medical audit.
5.Medical Audit Not as per guidelines & Templet of Tender Notice
6. Hospital Audit not as per Guidelines & Templet of Tender Notice
7. Claims deducted even after authorization
8. Claim rejection on flimsy grounds
9. Disrespect to the Hospital and doctors by inspection team
10.No Timely Payments : No payments for last 60 days.

IMA-Punjab have had several meetings with previous Health Minister Balbir Singh Sidhu, Chief Secretary Health & CEO State Health Agency and was hopeful by virtue of their assurance that problems will be redressed but after taking over of Insurance part by SBI General things have rather turned more sore and difficult.

Recently also we had meeting with Health Minister S. O.P.Soni Ji & Principal Health Secretary Vikas Garg they both listened to our problems and assured us of the release of payments this week.

Black days for patients begun; private hospitals stopped admitting patients under PMJAY. Because almost every hospital has so much pendency of claims that now it’s impossible for smaller and medium size hospitals to meet out their day to day expenses in the form of salary /electricity bills and likewise.

“We have sent emails to Prime Minister, The Chief Minister Punjab The Health Minister, The Principal Health Secretary Punjab,The CEO-SHA Punjab The Assist. CEO-SHA Punjab,Dr. RS Sharma,CEO-NHA,Dr. Parveen Gedam , Addl. CEO-NHA ,Dr. Vipin aggarwal,Dy CEO-NHA ,Dr. J L Meena, Joint Director NHA Parminder Gautam Principal Consultant NAFU ,Grievances Cell SHA Punjab Rohit Jha,Director State Cordination NHA ,President, IRDA and requested them to kindly take immediate steps to resolve problems and ask the officials to make payments of claims, submitted upto 07-10-2021/as per guidelines of 15 days, released by 22-10-2021. And in case of non-receipt of claim payments it may not be possible for us to pass the benefits of the scheme to needy patients from 23-10-2021 and it is also required to rebuild the shattered confidence of us” said Dr Neeraj Goyal ,IMA Patiala President

“Now as our legal and genuine demands are not met and we have been exhausted off our finance we have stopped taking new patients and will resume taking new patients only after complete claim payments are received and other issues are resolved” said Dr Nidhi Bansal, hony. secy. ,IMA Patiala