Changes in the Invoices in the Health Sector

Changes in the Invoices in the Health Sector

There is increased activity and negotiations between insurers and medical clinics since the beginning of May, which appear to be leading in changes in the invoicing of health insurance policies starting from the second semester of this year. The two sides (insurers and clinics) appear to be moving forward with the creation of new indemnity tables (of doctors’ fees, pharmaceutical supplies, and hospitalizations) which will preserve the margins of profit for the clinics as well as the benefits offered to insurers’ clients.

The health insurance industry is rising steadily wihile the “medical inflation” is now modulated at far lower levels than it was two years ago.

The clinics are suffering from the cut backs in payments (claw back and rebate) that have been enforced by the National Agency of Health (EOPYY) in provided services and medications, and are in a state of decreased liquidity. Clients, at over 50%, use private insurance companies for lengthy hospitalizations and surgery payments (surgeons, anesthesiologists, assistants) according to indemnity tables adapted to 2013-2014 conditions, when the liquidity at private clinics was at a better state. Now, however, according to  information, most private clinics wish to revise the indemnity tables in a way that allows liquidity margins for the clinic.

Insurers, in their turn, consider health insurances might be rising fast, but the companies must preserve a state of balance among benefits – indemnities – premiums, in order to maintain profitability in the domain of health insurance and, at the same time, provide quality services to their insured and offer attractive packages in relation to the ever increasing competition. So, for instance, they maintain inflated indemnity tables for specific services (surgeries) while reducing hospitalization covers or discontinuing contracts with diagnostic centers, as they consider that in this domain (diagnostic centers) there is direct competition between insurance and bank products.

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