THESE Health Insurance Providers May Not Offer Cashless Treatment Next Month, Is Your Policy On The List?

Lakhs of health insurance policy holders of Bajaj Allianz General Insurance and Care Health Insurance are at risk of losing their cashless treatment benefit at over a thousand hospitals.

The Association of Healthcare Providers-India (AHPI) has directed its network hospitals to suspend cashless treatment facilities for Bajaj Allianz General Insurance from September 1, 2025. AHPI has also given notice to CARE Health Insurance; however, there is no information about cessation of treatment for CARE policyholders, reported Economic Times.

AHPI is scheduled to meet with CARE Health officials on Wednesday and Bajaj Allianz General Insurance on Thursday this week to address these issues and resolve the problems amicably.

The AHPI has a network of over 20,000 hospitals, which includes top names like Max Super Speciality, Fortis Escorts, and more.

What Is a Cashless Treatment Facility?

Many health insurance providers offer the facility of cashless treatment to their customers, where they can avail themselves of medical treatment without paying any money out of their pocket. In such cases, the insurance provider directly settles the customer's claim with the hospital.

Cashless treatment is only offered at selected network hospitals, and customers are notified in advance about these hospitals. In the absence of these facilities, customers are required to pay the hospital bills by themselves and then submit the claim to insurance for reimbursement.

Which Insurance Policy Holders Will Not Receive Cashless Treatment Facility?

As of now, only Bajaj Allianz General Insurance policyholders will not receive the cashless treatment facility at AHPI network hospitals from September. The hospital network body has also sent a notice to CARE Health Insurance, but a confirmed decision is awaited.

CARE Health Statement On Matter

CARE Health Insurance released an official statement, saying that it is attempting to amicably solve the issue with the forum and will keep its customers' interest on priority.

"The said communication is generic and does not carry any details such as, names of affected providers, tariff or claim deduction challenges etc. We have had a sustained, progressive association with AHPI, and even today connected with the forum to get specific information in this regard. However, they were unable to provide any specific details. We have also reached out to hospitals ( Members of AHPI) who haven't mentioned any challenges with our services."

What Will Happen If Suspension Proceeds?

If the suspension proceeds, policyholders with Bajaj Allianz or CARE will need to cover medical expenses upfront and later seek reimbursement from their insurers. Dr. Girdhar Gyani, AHPI's director general, explained that medical inflation in India hovers around 7-8% annually due to rising costs in staff, medicines, and utilities. He stated that operating at outdated or reduced reimbursement rates could compromise patient care.

Why AHPI Is Breaking Tie-Up With Bajaj Allianz Health Insurance?

Bajaj Allianz has consistently rejected AHPI's proposal to review tariff rates biennially to align with medical inflation and has demanded tariff reductions, reported ET. Additionally, AHPI members have accused Bajaj Allianz of delaying claim settlements and discharge approvals.

Claim Settlement Ratios

The IRDAI's Handbook on India's Insurance Statistics for 2023-24 shows Bajaj Allianz with a claim settlement ratio of 95.99%, while CARE Health stands at 92.77%. This ratio reflects how many claims are honoured out of every 100 received by an insurance company.

Currently, AHPI has approximately 615 network hospitals in Delhi-NCR, around 511 in Punjab, 242 in Uttarakhand, and about 1,220 in Uttar Pradesh. The ongoing discussions between AHPI and the insurance companies aim to resolve these disputes amicably while ensuring patients continue receiving necessary healthcare services without financial strain.