Empanelment of Hospitals and Revision of Rates for Various Treatments
1.0 Brief Introduction:
A policy for empanelment of hospitals and periodical revision of rates of treatment for employees of the organization has been developed. Delegation of powers for approving various proposals in this regard has also been defined.
Empanelment of Hospitals for the purpose of providing cashless medical facility to the employees from the empaneled hospitals in the Organization was being done by the Committee taking into consideration credentials, proximity etc. of the willing hospitals. The rates were finalized after negotiations and generally these were revised every two years and since there was no policy in vogue as regard to revision of rates, in case of some hospitals same were being revised on yearly basis.
Further, in certain cases, the empaneled hospitals were either not providing cashless treatment or asking for higher rates than the approved one and in such cases employees had to make the payment of difference in amount of rates approved and charged by the hospital. The procedure for de-empanelment of the hospital was also not defined and every time a new Committee was formed as and when empanelment of the hospital was required.
A committee was appointed to study all aspects of empanelment of hospital and approval of rates. In view of the recommendation of Committee new medical policy has been framed with the main objective to provide facility of cashless medical treatment to the employees of the organization. A standing Committee has been constituted for empanelment of the hospitals and agreement is signed between the organization and the empaneled hospital which would have legal binding on both the parties.
1.3 Impact and Benefits:
New medical policy has curbed the arbitrariness and discretion in financial and administrative decisions with reference to empanelment of the hospitals, reimbursement etc. and has ensured transparency.
The agreement signed between MDL and empaneled hospital has a legal entity and in case of deficiency in services on the part of hospital, the hospital can now be de-empaneled as per the procedure laid down in the policy.