CMC wary of state insurance scheme over payment dues

In a latest incident, which highlights the hospital’s attitude towards such patients, the family of Parthiban (21), of Naryanapuram near Jolarpet, who broke his leg after accidentally falling from a tree, was told they had to pay for the treatment.

Parthiban, son of an agricultural labourer, was rushed to the CMC hospital on Monday after his fall. However, emergency ward staff were reluctant to accept the CMCHIS card they were shown and insisted on payment.

When contacted regarding the incident, CMC director JV Peter said, “One reason why we hesitate to accept health insurance cards is that we have outstanding dues of more than Rs 18 crore. Some of our insurance claims are pending for more than three years.”

The director later said, “Femur break is not covered under health insurance under the CMCHIS in private hospitals, but it can be done in government hospitals.” As far as Parthiban’s case was concerned, “Since the patient’s father was an agricultural labourer, he will have to pay only Rs 15,000 for the entire treatment, which would have exceeded a lakh.”

Asked about the insurance dues, Peter said, “Insurance companies always put up some query or the other, which ends up delaying the payment.”

Elaborating further, Peter said, “Insurance companies have told us repeatedly that if we were in Chennai, they would gladly depute a person to look into the issue but nothing could be done as we are based in Vellore.”  

When DT Next reached out to state Health Secretary J Radhakrishnan, he said, “Insurance claims are annual and hence they have to be settled immediately.” Stating that he would call up the CMC regarding this issue, he said, “Issues arise only when package treatment is needed by patients. If CMC informs us about the pending claims, we shall take steps to ensure early settlement.”

When asked about this, an insurance company representative said, “We can go only by individual cases. However, we will consider the issue at the earliest.”