Max Healthcare is in a stalemate with Max Bupa Health Insurance Co. Ltd and has discontinued cashless treatment in its chain of hospitals, leaving policyholders in a fix as they will not be able to avail the cashless claim facility.
Max Bupa is a joint venture between Indian private equity firm True North and UK’s healthcare services firm Bupa.
Max Healthcare is the amalgamation of the erstwhile Max India into Max Healthcare and the demerger of the healthcare business of Radiant Life into Max Healthcare.
“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 spokesperson for Max Healthcare.
A spokesperson for Max Bupa said the insurer is in talks with Max hospitals on revised tariff plans, which is a routine exercise. “Temporarily, our customers will not be able to avail 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,” the spokesperson said.
According to insurance industry experts, this is not the first such instance, but it is not very often that a healthcare provider de-empanels an insurer. In most cases, insurers drop healthcare providers from its network if it finds the partnership unsustainable.
An expert, seeking anonymity, said large-scale de-empanelment is rare and happens only when insurers fail to clear outstanding dues of a hospital or do not agree with the revised rates.
Earlier, a similar instance was seen when public sector insurers delisted many large hospital chains following a disagreement over rates offered by the General Insurance Public Sector Association (GIPSA).
“Insurers had de-empanelled the hospitals and it took a few months to get resolved. It’s incumbent on both hospitals and insurers to resolve issues smoothly because hospitals may lose patients and confidence in the insurer may go down if some policyholders prefer getting treated at a specific hospital,” said Abhishek Bondia, MD and principal officer, SecureNow.in, a corporate insurance broker.
Mahavir Chopra, founder, Beshak.org, an independent research platform for retail customers, said insurers are more dependent on hospitals and would want all major hospital chains to offer cashless services. “The negotiating power of an insurer isn’t much because policyholders decide on the doctor and the hospital, and then check whe-ther the cashless treatment option is available. 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,” he said.
A Max Bupa spokesperson said customers will be able to avail the cashless treatment facility at Max hospitals within two weeks.