Shillong, September 10 : The State Nodal Agency – Megha Health Insurance Scheme (SNA -MHIS) on the 2nd September 2024 received a letter from the Private Hospitals of Meghalaya expressing their concerns on the implementation of Megha Health Insurance Scheme – Pradhan Mantri Jan Arogya Yojana at the hospitals. The letter expressed various concerns regarding Claims Processing and Claims Settlement.
Similar concerns had been previously brought to the attention of the SNA-MHIS by private hospitals.
These concerns were addressed during the State Grievance Redressal Committee (SGRC) meeting held on 7th August 2024 and steps were taken to resolve the issues. Despite these efforts, certain challenges persisted, due to issues related to the technological platforms used for claims processing and payments. Subsequently, the private hospitals had expressed their grievances through a letter to the Chief Minister.
Following the letter received on 2nd September 2024, the SNA-MHIS immediately convened a meeting with private hospitals to address the concerns. During this meeting, the hospitals informed the SNA-MHIS that they would temporarily suspend cashless services for MHIS-PMJAY patients until the issues were fully resolved.
Consequent to the meeting held on the 2nd September 2024, on the 3rd September 2024, the private hospitals informed the SNA-MHIS through a letter, stating that the Private hospitals are willing to extend cashless benefits to MHIS-PMJAY patients but the issues highlighted in the letter should resolved at the earliest.
To address the issues raised by the private hospitals, the CEO of MHIS, along with a team from the SNA-MHIS, held discussions with officials from the National Health Authority in New Delhi. The team from the SNA-MHIS along with the Insurance Company were stationed at the National Capital for 4 days to resolve the pending issues. As per the reports of the Insurance Company a total Claims Settement of Rs. 3.59 crores has been made from 2nd September 2024 to 9th September 2024. A total of 1,89,018 cases have been raised under MHIS VI between 15th September 2023 to 31st August 2024, out of which 1,55,211 (82%)cases has been approved and 29,415 (18%)cases is pending. The pending number of cases is for both public and private hospitals. This should be cleared within the next two weeks.
While most of the technical issues have now been resolved, a few challenges remain. To ensure continued progress, the CEO of MHIS is conducting weekly reviews with the Insurance Company to follow up on the unresolved matters. The Health Minister is constantly monitoring the situation for timely resolution. Officials of National Health Authority also have assured of daily monitoring until this is sorted out.
Furthermore, the Government of Meghalaya has extended the policy of MHIS Phase VI from 15th September 2024 to 31st August 2025 with a sum insured of Rs. 5,30,000 per household.
All eligible beneficiaries in Meghalaya excluding state and central government employees can avail the benefits in all Empaneled Hospitals under the scheme.
