KATHMANDU, Jan 15: Tribhuvan University Teaching Hospital (TUTH) has stood its ground on its decision to suspend health insurance services from mid-January, saying it has not revised the announcement made earlier this week. As of Wednesday afternoon, hospital officials confirmed that the decision remains unchanged. TUTH had issued a notice on Monday stating that health insurance services would be discontinued from January 15.
Hospital officials say the move comes amid mounting financial pressure caused by the Health Insurance Board’s (HIB) repeated rejection of payment claims and unilateral revisions to treatment rates. TUTH has demanded that reimbursements be made based on its approved rates and that unnecessary hurdles in the claims process be removed, making it clear that services can continue only if these concerns are addressed.
In response, the HIB said it has held both formal and informal discussions with the hospital and sent a letter seeking the continuation of services. HIB Chairperson Chandra Bahadur Thapa Chhetri said the Board has requested TUTH to reconsider its decision and assured that legitimate demands would be addressed through an expert committee.
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He acknowledged the hospital’s concerns as valid and said a team tasked with improving the overall health insurance system is working on the issue, with implementation to follow once procedures are completed.
TUTH, however, remains unconvinced. TUTH Director Dr Subhash Acharya said the Board’s letter fails to formally accept the hospital’s demands, accusing the HIB of delaying the issue without a clear decision. He added that treatment rates applied to government hospitals in the Kathmandu Valley are incompatible and financially burdensome for TUTH.
According to Dr Acharya, the hospital has been suffering monthly losses of Rs 20 million to Rs 30 million due to rejected claims and pricing discrepancies, with total losses nearing Rs 1 billion since the insurance service began. Nearly half of treatment costs are routinely rejected, he said, noting that similar challenges have forced other hospitals, including Sahid Ganglal National Heart Centre, to discontinue health insurance services.
The HIB, meanwhile, insists that the TUTH’s demands are being addressed through the expert committee. Chairperson Thapa reiterated that the issues raised are legitimate and that efforts toward a solution are underway.
If TUTH proceeds with suspending health insurance services, around 500 to 550 patients are expected to be affected daily. Hospital officials said most of them are critically ill patients referred from outside the Kathmandu Valley.
