GIPSA can be defined as an amalgamation of the topmost 4 insurance companies, which are “public sector” in nature. The name of the insurance companies are as follows:-
- Oriental Insurance Company,
- New India Assurance Company
- National Insurance Company
- United India Insurance Company
Limited cashless services are provided by these four public sector insurance companies. These services are only provided to those hospitals who are ready to accept their price structures. And also are ready to get connected with a network provider preferred by them (preferred provider network or PPN). According to the latest batch of data available, a total of 5.49 crores policyholders have been impacted by the new decision taken by GIPSA.
It was only a matter of time until GIPSA’s latest decision would face hurdles in the court of law. So in the “Bombay High Court”, a PIL was filed against the newest decision taken by GIPSA. The ground of the PIL was that whenever a customer goes to a hospital for treatment, he always pays a part of treatment expense in cash, which is then not refunded by the third-party administrator neither partially nor fully. The customer has to pay a certain amount in cash because of the unavailability of a completely cashless insurance facility. The TPA (Third Party Administrator) can refuse to pay the refund on multiple grounds.
But the insurance companies have a completely different viewpoint on this. According to them, through this decision, they are enhancing the financial structure of the entire medical system. The council members of GIPSA say that the PPN (preferred provider network), will both modify and justify the cost structure, especially for the patients. The rationale offered by these insurance companies is that with the availability of standard packaged and fixed rates, customers won’t have to pay a penny more to the concerned health care facilities. And the total amount which has been insured will be used most coherently under the chosen health care policy.
But that’s not all there is to the discussion. According to a large number of experts, if there is an increase in the number of healthcare claims, then the customers will also become liable to pay a higher premium amount in the long run. At Lagalraasta, we will help you in getting your facility to get “GIPSA impaneled”. Our team of experts will work round the clock for you and provide a completely hassle-free service.
A total of 560 hospitals have already got themselves impaneled under GIPSA. But the premier health care facilities like Fortis and Apollo, do not prefer to get themselves impaneled under GIPSA. Because they do not seem to agree with the standardization of rates allowed by GIPSA. The topmost hospital chains severely disagree with the standardization of rates, because it doesn’t seem to be a viable option for them in the long run. A large section of private insurance companies is not relying on TPA for settlement of any kind of medical claim. Because they perform the settlement process in their house only, But a joint venture is being planned by most public sector companies. This joint venture will be with TPAs so that the medical claims of the GIPSA members can be processed. If this move becomes successful, then a lot more hospitals will get under the umbrella of the PPN network. And to enhance the operational capacity, new benchmarks for customer service will be developed in this matter. The decision to standardize the rates of key medical services has been applied in most metropolitan cities. But in case a customer decides to gets his treatment done at a Non-TPA hospital, then they should make sure to inform their TPA within a specified period and ensure that they have made complete payment to the hospital. This will make sure the reimbursement process of the treatment expense very smooth. The reimbursement will only be done by the TPA when the
- ID card
- Policy copy
- Discharge summary
- Payment receipts
- Investigation reports
- Signed claims,
have been provided to it in the correct format.
But these new decisions by GIPSA have caused a lot of problems for the new customers also. Because according to them, a total of 80% of the medical expenses must be re-paid, but instead only 60% of the total expenses are being reimbursed to them.
It must also be noticed by medical policyholders that GIPSA does not permit the use of alternative medical treatment options under its policies.
Getting impaneled has both its pros and cons.
How Legalraasta will help in getting your hospital impaneled?
So, if you want to get your healthcare facility impaneled under panel then we are only a call away. We will be with you through every step of the process. And also make sure that your healthcare facility gets impaneled in the most hassle-free manner.