Kozhikode: Private hospitals are to stop providing medical treatment under the Medical Insurance for State Employees and Pensioners (MEDISEP) scheme, citing the delay in settling the claimed amount and paying only a minimal amount.

Some hospitals have started informing the Government that they have practical difficulties in continuing with the scheme. Even those hospitals which have tied up with the MEDISEP, have cut down on the areas of treatment covered under the scheme.

While one can avail of treatment in orthopaedics, cardiology, and general medicine departments, childbirth is not covered by most hospitals. Some hospitals which had allowed ‘delivery’ under the scheme insist that it is covered only for two childbirths. Strangely, the claims forwarded by the hospitals were denied citing that if the children from the first two deliveries are alive, the third delivery will not be covered under the scheme.

As MEDISEP was implemented in a hurried manner, many hospitals still have no clarity regarding the proceedings. The insurance company is refunding only the package amount prefixed for each disease or treatment, to the hospital. Owing to this, altercations between the patients and the hospital authorities have become a regular affair.

Complaints aplenty; not getting proper responses: Hospital authorities 

The claimed amount – the actuals spent for the particular treatment - is being cut down and paid, complains Hospital authorities. The refund of the final approved amount is also being delayed. 

As per the agreement, the refund will be credited to the hospital account within 15 days of the patient's discharge. However, there are some hospitals which have not even received Rs 1 refund even after one and a half months since the scheme rolled out.

Although it was earlier said that the room tariff, surgery charges and implant cost can be individually claimed, now it is all said to be part of the package rate. The hospitals are to bear the brunt. Calls are not answered on the phone numbers provided to make such complaints. The hospitals also complained that there are no clear responses from the supervisory agencies.

The nodal agencies dealing with MEDISEP informed that the technical complaints regarding the scheme are being addressed and resolved. Every detail is clearly mentioned in the agreement on MEDISEP. The hospitals are making a hue and cry without clearly understanding the terms therein.

The authorities claim that the refund process has started for many hospitals. There would be technical issues related to the bank accounts which could be why some are not getting the refunds, the authorities said.