Claims worth Rs 3.59 crore under the Megha Health Insurance Scheme (MHIS) have been settled by the insurer since September 2, MHIS CEO Ramkumar S informed today.
It was on that day last week that private hospitals in Meghalaya expressed their concern over pending insurance claims. The total pending was given as Rs 48 crore of which Rs 18 crore was for private hospitals.
The problem, it was reported, was issues related to the technological platforms used for claims processing and payments. At first, the hospitals informed the MHIS that they would suspend cashless services under the insurance scheme until the issues were fully resolved but backtracked the next day as the move would have hit poor patients to a large extent. However, the hospitals insisted that the payment issues be resolved at the earliest.
To address the issues raised by the private hospitals, Ramkumar and a team from the MHIS held discussions with officials from the National Health Authority in New Delhi. The Meghalaya team along with the insurance company, Reliance General Insurance Co Ltd, were stationed in the national capital for four days to resolve the pending issues.
As per the reports of the insurance company, a total claims settlement of Rs 3.59 crore has been made from September 2 up to today, the MHIS said in a press release.
A total of 1,89,018 cases have been raised under MHIS 6 between September 1, 2023 to August 31, 2024, out of which 1,55,211 (82 percent) cases have been approved and 29,415 (18percent) cases are pending. The pending number of cases is for both public and private hospitals. “This should be cleared within the next two weeks,” the release signed by Ramkumar said.
While most of the technical issues have now been resolved, a few challenges remain. To ensure continued progress, the MHIS CEO is conducting weekly reviews with the insurance company to follow up on the unresolved matters and the Health Minister is monitoring the situation “closely”.
Meanwhile, the state government has extended the policy of MHIS 6 from
September 1, 2024 to August 31, 2025 with a sum insured of Rs 5.30 lakh per household. All eligible beneficiaries in Meghalaya excluding state and central government employees can avail the benefits in all empanelled hospitals under the scheme.
