MEDISEP: Several private hospitals breach terms and conditions

Thiruvananthapuram: Less than a fortnight since the rollout of the Medical Insurance Scheme for State Employees and Pensioners (MEDISEP), some private hospitals have been blamed for violating the norms agreed upon earlier as the Kerala Government sealed the cashless hospital treatment facility with a leading general insurance firm.

As per the complaints patients are being turned away from a few hospitals stating that the MEDISEP does not cover certain diseases. Some hospitals have also started putting up a list of treatments and medical procedures that are not covered under MEDISEP.

Exclusion of some health conditions or diseases from free insurance cover defeats the purpose of the scheme.

Government sources clarified that anyone can file a complaint against a particular hospital if its authorities do not accept the State’s insurance scheme.

Pressure from private insurers suspected

A few hospitals are not willing to cover certain treatments through the MEDISEP even as the same ones are being covered by other private insurance companies. It is alleged that this is due to pressure from private insurers.

Most private hospitals are keen on providing treatment for conditions fixed at high rates under MEDISEP. They are reluctant to provide treatments which entail minor expenses.

Demand for money despite cashless cover

There are several complaints that hospitals demand extra cash from those who availed a treatment on their MEDISEP cards. Many pensioners and government employees have already shared the documents of the same as evidence on their social media platforms.

As per the agreement, the treatment must be provided to the patient based on the rates fixed by the government. The government has fixed different rates for room tariff and other expenses after grading the hospitals. The patients need to spend from their own pockets only for food and other incidental expenses.

Undermining all these, certain hospitals are said to be demanding extra money as they please.

Many are yet to get their cards

On a day, approximately 75,000 individuals download their MEDISEP cards from the dedicated portal. Considering the high traffic, the server capacity has been increased. However, many are yet to get their cards downloaded. In some cards, the names of the dependents are not listed too. For solutions to such issues, the government has directed the pensioners to contact the treasury while the government employees are to approach the Drawing and Disbursing Officers (DDOs).

Very few hospitals listed

One major drawback pointed out by the government employees is that the number of hospitals tied up for the MEDISEP is very few. In most districts, the government has not been able to bring the main hospitals under the scheme.

As of now, all government hospitals and 240 private hospitals have been listed under the scheme. However, most of the private hospitals listed are eye hospitals.

A lobby of large private hospitals in Thiruvananthapuram still gives a cold shoulder to MEDISEP. The private hospitals have apparently informed the insurance company (Oriental Insurance) that they are ready to take up only organ transplant surgeries, which would be profitable for them.

Though the medical insurance scheme is mandatory for government employees and pensioners, the eligible

may have to rely on unlisted hospitals as the listed ones are negligible at least in their nearby areas.

Lack of reimbursement facility for treatments availed in unlisted hospitals is another drawback.

Hence, the state employees and pensioners demand that the scheme should not be made mandatory as they are being imposed a premium charge of Rs 500 every month and the insurance coverage for the treatment is not being ensured.

Where to complain

MEDISEP users can call on the toll-free number and voice their complaints and problems related to the health insurance scheme, say government authorities.

Calls would be attended on the government’s toll-free number: 1800 425 1857 from 10.15 am through 5.15 pm. Besides, the users can also contact the 24-hour toll-free number of the insurance company: 1800 425 0237.

The government authorities claimed all MEDISEP claims made so far have been approved. They also vowed that all attempts to undermine the scheme would be strongly resisted.

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