Kathmandu. Under the health insurance programme, private health institutions will not be able to pay insurance claims if they provide treatment to general patients under emergency service.
Issuing a circular on June 3, 2018, in the name of private health service providers associated with the health insurance program, the Health Insurance Board took this decision. The Insurance Board has informed that this decision has been taken on the basis of the decision of May 25.
On May 22, the Insurance Board had suspended all health insurance services except emergency services from private hospitals in view of the financial crisis. However, the Board issued this circular after the number of insured people started increasing to avail health insurance services through emergency service in private health institutions.
The Circular has directed the private health institutions to provide emergency health service only if the health condition of a patient is found to be of the nature of requiring emergency treatment in course of implementing the decision of May 26. If such emergency patients need admission (IPD) or surgery (OT) during treatment, they can be treated and discharged as per the treatment schedule, the board said.
However, the Board has made it clear that such claims will not be paid if the insurance claim is submitted by providing treatment under emergency service to patients of normal nature. “This will be done in accordance with the prevailing laws,” the circular states.
Similarly, the board has also urged the insured to fully comply with this circular. “We urge the health institutions and health workers providing the service not to exert unnecessary pressure on them by following this notice and to cooperate by getting the necessary health services as prescribed,” the circular reads.
