KATHMANDU, Jan 12: Tribhuvan University Teaching Hospital (TUTH) has announced it will suspend its health insurance program starting January 15, citing unresolved financial disputes with the Health Insurance Board (HIB).
In a public notice, the TUTH said the decision comes after repeated attempts to resolve a discrepancy between the treatment rates set by the Health Insurance Board (HIB) and those charged by the TUTH, noting that their repeated submissions on the issue went unheard. TUTH has been covering its daily operational costs from its own resources for the past two years, and can no longer absorb mounting losses.
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TUTH Executive Director Dr. Subhash Acharya said the hospital was left with no choice after the HIB repeatedly rejected claims, making the insurance program financially unsustainable. He added that the service could resume if improvements are made to the referral system, treatment fees are aligned with Kathmandu Valley hospitals, and other charges are properly adjusted.
“Every month, TUTH submits insurance claims worth around Rs 50 million, but nearly 40 percent of the amount is rejected,” Dr. Acharya said. “This has caused monthly losses of Rs 15–20 million, leaving Rs 400–450 million unpaid over the past two years.”
He also highlighted problems with claim rejections when patients are referred between departments. “For example, if a patient comes for heart treatment but develops an orthopedic issue, the claim for the additional care is denied. How can a patient not have another medical condition?” he said.
Despite raising these issues with the HIB and the Ministry of Health and Population from the beginning, Dr. Acharya said the hospital’s concerns remain unaddressed.
As TUTH serves as a key referral hospital for patients from across Nepal, the suspension of the insurance program is expected to create serious hardships for patients. Attempts to contact HIB officials, including the director and information officer, were unsuccessful.
