Ahmedabad Hospitals Stops Cashless Claims for Tata AIG, Star Health, and CARE Health Insurance

The Ahmedabad Hospital and Nursing Home Association (AHNA) announced that several hospitals in Ahmedabad have stopped accepting cashless claims for Tata from Tata AIG, Star Health, and Care Health.

Policyholders can still claim reimbursement for their treatment in hospitals, where a cashless option is not available. The current issue only affects cashless claims. Also, this isn’t the first time such disputes have happened. Dr. Gadhavi, AHNA president, explains that several number of complaints were filed in the last year by policyholders against these 3 insurance companies.

Data from the IRDAI handbook reveals that during 2023-24, CARE Health received 6,492 complaints, and Tata AIG got 3,792 grievances. On the other hand, Star Health recorded 16,603 complaints, which is the highest among all insurers.

Dr Bharat Gadhavi said that insurers are unfairly removing or blacklisting hospitals and not updating treatment rates as per rising medical expenses. If this issue is not solved soon, cashless claims with these insurers may stop across all of Gujarat.

In response to this, the insurers have accused AHNA of making invalid and misleading claims and that hospitals did not make any efforts to reach out to them directly.

Insurers said that these blacklisted hospitals were accused for their involvement in illegal practices and therefore insurers removed these hospitals from the list of network providers to protect policyholders from the rising costs that affects the insurance policy.

TATA AIG said that it wants to make sure that its customers continue to get healthcare services at affordable premiums without any inconvenience.

Star Health also stated that it would take legal action against AHNA if it makes any attempts to harm its reputation. It further highlighted that AHNA has not made any efforts to engage with them directly. Only a few hospitals were inspected for fraudulent activity, and after review, some were removed from the cashless network or suspended.

CARE Health didn’t comment, but Star Health said their cashless services are still running smoothly in cities like Ahmedabad, Vadodara, and Surat. However, they found repeated fraud and irregularities in cashless claims settlements in Gujarat.

Cashless claim settlements and network hospital access remain low in Gujarat.

According to IRDAI data, out of 6,75,903 lakh health insurance claims in the state, about 67% were settled through reimbursement, while only around 29% were done through the cashless mode.

The number of settlements done through reimbursement mode is higher than the national average, where only 36.68% of claims were settled through reimbursement, and 60.60% of the claims were settled cashlessly.

Amid these disputes between AHNA and the insurance companies, it’s the policyholders who suffer most when cashless services are denied. It is still unclear if the insurance regulator, IRDAI, will step in to protect customers’ access to cashless claims.