Getting around the cashless imbroglio

Would you like it if a shopkeeper offers you a product at one price and gives the next buyer a 50% discount? None of us would.
But this practice happens in several industries. Airlines and hospitals are prime examples. Airlines justify their different prices for a seat on the same route on the basis that some passenger book in advance and hence, get a special price.

Now, look at hospitals. If you are admitted in a hospital and an operation needs to be performed, the price varies depending on which ward you are admitted in. If you are from the general ward, you pay a lower amount for an operation and you pay a much higher amount if you happen to be from a deluxe room. The charges can be substantially higher, in spite of the fact that the doctor, operation theatre, etc, are the same.

Now, the second problem — many hospitals have ostensibly been charging a high amount if a patient has insurance cover and an entirely different (and lower) amount if the patient does not. This has been one of the worst kept secrets of hospitals and such, their modus operandi has been bleeding the insurance companies. It’s ironical that insurance companies are charged higher rates — they should actually be charged lower rates and get quantity discount, as they provide huge business to various hospitals.

Some hospitals accuse the insurers of not having ailment-based cover and having just a value-based cover, due to which the insured goes for expensive treatments. They say charges can vary from hospital to hospital, based on facilities available. But
the issue is that hospitals have different tariffs for those having insurance and those without.

Now, PSU insurers have decided to stop cashless settlement in all but a select list of the preferred provider network (PPN), where cashless will be applicable. Private insurers are continuing the cashless facility.

Consumers are thinking, do I go to the private insurers — who are offering cashless settlement across hospitals as against the PSU insurers?

This alone should not be a determinant. Today it is PSU insurers. Tomorrow, it could be the private ones too. PSU insurers have got affected most in this as their premiums have been comparatively less.

Meanwhile, here are some tips to see you through the crisis:
> Keep some cash
Till the dust settles down, it would be a good idea to pay the bills and get reimbursed later. That way, the bills will be more in line with the services availed. Also, it is a good idea to fix in advance the rates for procedures and fees of doctors and only then get hospitalised. In all but emergency cases, this should be possible. This can help you get a fix on how much it would cost and be ready with the finances.

> Be flexible
A lot of people are attached to their doctors. And they go to certain hospitals simply because their doctor has recommended it.
Be flexible and be willing to move to a different doctor or hospital, if you know your current preferred doctor/ hospital is over-charging you. There is nothing better than a bit of competition — get quotes from different doctors and hospitals. You could be able to save quite a packet if you find someone who offers you a better deal.

> Check the bills 
One problem noticed with patients who have insurance is that they do not bother much about checking the bill, as long as the same is settled in a cashless manner. But inflated claims by a hospital reduce the residual cover available for the year. Also, inflated claims result in extra premium charged, in the next year.
Signing the bills without checking them will also expose the insured to allegations of fraudulent claims, if some procedure was not done but claimed for.

To ensure that no excessive or fraudulent claims are being made, you can take the help of the medical professionals in an insurance company or get the same checked by an external medical professional, before signing papers. Resist attempts by doctors or hospitals into pressuring you to sign on the dotted line.

The writer is a certified financial planner who runs Ladder7 Financial Advisories and can be contacted at ladder7@gmail.com