Centres health insurance scheme ailing in state

KOCHI: Rashtriya Swastya Bima Yojana (RSBY), a flagship programme of the UPA Government aimed at providing insurance coverage to BPL families in the country, is in a pathetic state in Kerala. The beneficiaries of the scheme are not able to avail themselves of treatment as many private hospitals are backing out from the scheme owing to various reasons.As per the scheme, the BPL families are entitled to hospitalisation coverage of up to Rs 30,000 from private and government hospitals empanelled under the scheme. It was   functioning well for the initial months but of late many issues are deterring the private hospitals from offering treatment under the scheme.The private hospitals are not getting their money back on  time for the treatment provided. “People think that for any  treatment the cost is free up to Rs 30,000, but only a fixed   amount is reimbursed under the scheme. As more number of people have this misconception, and as we can not deny them treatment, we have incurred loses,” said Radhakrishnan N, health insurance scheme manager of Amala Institute of Medical Sciences, Thrissur.“We have stopped the scheme operations for the past eight months but are willing to go forth if some rules of the scheme are changed,” he said.When enquired about the reimbursement delays, the United India Insurance Co Ltd, the insurance company for the RSBY in Kerala, said many hospitals were misusing the scheme by providing fake bills.“Hospital authorities are holding the cards of the patients  so that they can swap the card for unnecessary tests,” said George De Das, administrative officer, United India Insurance.The insurance agency has terminated some hospitals because of the extra bill they claimed. The authorities of Daya Hospital, Thrissur, said they had to  get over `80 lakh from the insurance company. “Our main loss  came from the dual procedure treatment where a patient sometimes has to undergo treatment for another ailment. But,  the insurance agency does not reimburse the extra treatment amount,” said S Jayarajan, administrative officer of Daya Hospital Thrissur.Another private hospital which has backed out from the hospital claims that only Rs 500 can be swapped on a day which includes accommodation, investigation, room rent and tests. “But, this is not feasible,” said the hospital sources. All major treatment rates are subsidised under the scheme. For caesarian section, it is Rs 8,000 but some hospitals charge over Rs 10,000. The scheme could only be implemented in the hospitals which were ready to treat for the said amount. With insurance companies not paying the extra amount and private hospitals backing out, the real beneficiaries are left to suffer.