Max Hospitals stops cashless treatment for policyholders of these 3 insurance companies
Niva Bupa, Star Health and Care Health Insurance are significant names in the health insurance business. But their customers will not be entitled to cashless treatment facility at Max Healthcare hospitals, which runs several super specialty hospitals in the country.
Kolkata: Max Hospital is a prominent name in modern healthcare in north India. Niva Bupa, Star Health and Care Health Insurance are significant names in the health insurance business. However, in a recent development, it has been decided that the customers of the three insurance companies cannot get cashless treatment facility at Max Hospital. Earlier, the hospital decided to discontinue cashless facility to the customers of Bajaj Allianz, another prominent private sector health insurance company. No unit of Max Hospital will offer this facility to any customer of these four insurers.
However, Max Hospital will continue to offer healthcare services for which the customers can claim reimbursement from the insurers after paying for the treatment from their pocket. The office claim team will refund the expenses incurred by the patient. For this facility, the insurance companies will need the standard documents needed for reimbursement. These are discharge summary of the patient, all pathological and radiological reports, all prescriptions and doctor's notes, all bills, Aadhar card, PAN card and a cancelled cheque.
Hospital association AHPI had directed all member hospitals to stop the cashless treatment facility of Bajaj Allianz General Insurance from September 1, 2025. The hospitals where this will be enforced includes more than 20,000 hospitals including Max Super Specialty and Fortis Escorts. Later similar notice was also sent to CARE Health Insurance.
One has to note that AHPI has asked Care Health to reply by August 31. In the event of no response coming from the insurer, cashless facility will be withdrawn for Care Health policyholders as well. In that eventuality, the policyholders of Bajaj Allianz and CARE insurance policies will have to bear the expenses for treatment from their own pocket. Then they have to apply for reimbursement from the insurance companies.
What is the dispute about
Central tp the dispute is the difference in opinion between AHPI authorities and the insurance companies. AHPI director general Dr. Girdhar Gyani had said that medical expenses in the country are increasing at 7-8% every year on account of continuous revision of employee salary, medicines, medical equipment, electricity-water etc. Hospitals want to keep costs down but it is impossible to offer treatment at old rates. AHPI authorities have also said that Bajaj Allianz has been steadfastly rejecting the demand to revise treatment rates every two years; on the contrary this insurer has been insisting on reducing the rates. Hospitals have also alleged that Bajaj Allianz delays claim settlement and patients also get discharge approval late.