GIPSA, a group of four PSU to standardise rates for around 42 medical procedures across various categories of over 4000 hospitals for settling cashless claims.but is looting and cheating patient by GOOF-up with hospital and TPA.
1. GIPSA Rates in package is almost 4 times the rate that any patient can do a procedure under cash payment in same hospital. Cash payment rates r cheapest since in open market hospital faces completion with other hospital.
2. There is a confusion first, if (a). GIPSA decided arbitrary rates are same across all categories of 4000 hospitals in country
or (b) where the arbitrary rates are same across all categories of big or small hospital in any metro or that particular town, In both above case this is against public interest as the rates r. kept as high as possible to suit the costliest hospital. But this benefits maximum to the lower category of hospital.
In third (C) case, if GIPSA negotiates raters for that particular hospital but same for all patient in that hospital who r taking cashless treatment for that particular medical procedure under diffrent class of bed, this is even worst situation as there is maximum chance of hospital bribing GIPSA to get highest rates for any particular medical produce to be performed in cashless.
3. even if a poor patient takes a low category room still he ends u paying for the highest category charge that a patient of highest suit room pays for his surgery.. GIPSA package is same for all whether a patient has paid premium for a General or triple sharing room(thus a lower premium) or a single sharing room(higher premium)they are entitled to same amount of money being released by their insurance company to the hospitals for a particular procedure if the insurance amount is same..Fore example whether a patient delivers in in shared room or a single room ,hospital and doctor will get a total of Rs 35000,which includes bed charges,medicines,disposables,surgeons charge and all other expenses. Thus GIPSA loots the poor.
4. GIPSA has prepared different category packages for 42 (surgery) medical procedures. No transparency how a category is chosen and rates fixed for that category. Patient does not know if he has been rightly placed in the right category for his surgery by hospital. Hospital arbitrarily decides this higher category to squeeze out maximum profit not only from patient by exhausting his mediclaim limits but also from PSU which is nothing but public money. Hospital refuses to explain his placement into any such category. Hospital has no display or catalog or break up for sub rates charged in any give category. Thus here also GIPSA offers corruption chance with conspiracy between Hospital, GIPSA, PSU and TPA.
5. GIPSA creats monopoly and is against the earlier policy of creating complettion in 4 PSU. Like IRDA, should GIPSA also not get passed by both house of parliament before it start function arbitrarily.
6. No legal identity. What is Legal identity of GIPSA. Whether GIPSA is registered under any law of the land that is whether it is registered as a society or a trust or under Companies Act. ? In absence of any such legal identity it is a illegal association to cheat and commit fraud on public for arbitrarily directing hospital to charge rates which are many times more than prevailing market rate charged by that particular hospital for cash services.
7. In absence of no governing body that keeps track on the working of GIPSA makes It venerable to corruption.
8. TPA takes almost more than 8 to 10 hours to give final settlement approval for any medical procdure that is needed on patient to be performed. Due to this delay sometime the patient misses the surgery on that particular delay and his fasting during the day for surgery goes useless.
6 Same 8 to 10 hour time delay is noticed at the time of final discharge also. Since the patient is already in hospital for last several days and the TPA knows his case for last several days still why this delay in final discharge ?
My complain on issues on govt. portal is spending though there is norm that such complain should be completed within 2 months.
1. Dept of consumer affairs DOCAF/E/2012/00681 date of 22/5/12. Date of Action 31/5/12 forwarded to Core Section.
2. Insurance Division DEAID/E/2012/00265 dated 22/5/12 date of action 23/5/12 Forwarded to IRDA
3. Dept of justice DEPOJ/E/2012/00291 dated 23/5/12
4. Mahaarshtra State complain GOVMH/E/2012/00741 dated 20/5/12
