Over 10,000 health insurance claims of govt. staff rejected

Over 10,000 health insurance claims of govt. staff rejected

Collectors asked to constitute district-level audit teams

25/10/2021

Dennis S. Jesudasan CHENNAI

Over 10,000 claims made by Tamil Nadu government employees and pensioners under the New Health Insurance Scheme during the COVID-19 pandemic, especially between July 2020 and August this year, have been rejected. Since the number of claims rejected is huge, district-level teams have been constituted to audit the claims.

At a meeting to review the cashless treatment provided under the NHIS between July 1, 2020, and August 31 this year, “it was found that around 10,929 claims had been denied for various reasons,” the Commissioner of Treasuries and Accounts informed the Collectors.

The Commissioner asked the Collectors to constitute district-level teams to conduct sample studies of such cases and submit a detailed report before this month-end. The teams will each consist of the chief/senior medical officer, a treasury officer and a staff member of the insurance company. They will also undertake periodical sample studies (every two months) at major hospitals, and send reports to the office of the Commissioner of Treasuries and Accounts.

“Almost every employee has had to fight to get the insurance claims. There are also some inherent flaws in the scheme,” said P. Frederic Engels, State coordinator of the Contributory Pension Scheme Abolition Movement.

He highlighted a specific issue in the implementation of the scheme. Though the scheme was awarded to one company, there are two third-party administrators, he said. While one company had been earmarked for a few districts, the remaining districts had been allocated to another.

“It has been effected with a mere circular. When a government employee is admitted to a hospital in another district while travelling or after an accident, the third-party administrator says the other third-party administrator manages the affairs of that district. This causes an unnecessary burden on the patient. The cashless treatment is never cashless. Reimbursement should not be allowed at all, since it dilutes the very concept,” he said.

There are over 9.33 lakh State government employees and about 7.31 lakh pensioners in the State.