There were indications that CORIS Gipsa TPA JV will become operational by end of 2011 and as a result of the same New/National/Oriental/United (4 PSU’s) will shift their TPA work to the new company.
Tenders were floated and Coris, a French company was selected. Suddenly we find that JV is being dropped. Tendering/Selection process has come under cloud and it was decided by the high ups to avoid negative publicity by dropping this JV.
May be it is the end of the JV idea. Let us wait & watch.
Showing posts with label TPA. Show all posts
Showing posts with label TPA. Show all posts
Sunday, July 17, 2011
Monday, April 18, 2011
Are they supporting each other Or are they fighting with each other?
Recently we came across a news item that 64% of the cases which came up before Insurance Ombudsman (located all over the India) was pertaining to health insurance portfolio. Let us look at the facts;
Health Insurance as % of non life insurance portfolio = 32%
Group policies issued under Health Insurance portfolio = 50%
Policies issued to Individual/ Families = 50%
It means policies being issued to Individuals/ Families are only 16% of total non life insurance portfolio.
General impression is that claims arising from group policy get paid because they have the bargaining /negotiating power .It means that Individuals/ Families are the worst sufferers as this is the group which is having claims being disallowed.
The question before us is how many of the dissatisfied customers are able to reach the office of Insurance Ombudsman?
64% figure is really a very high figure .Let us try to look at the reasons for this scenario or why it is so?
There are 3 players.
Role of every player is to provide good service to the customer. When the insured has to go in for hospitalization then each one ( Insurance Company /TPA/Health care Provider ) is trying to pass on the buck to other player as if the objective or job description of each one is who can harass the customer most so that he runs away and forgets about claim .
Health care provider says that this insurance company is blacklisted or this TPA is black listed
TPA says that this health care provider is black listed.
Insurance Company says that they are ready to consider the payment of the claim but it will not be on cashless but on reimbursement basis. This defeats the basic assumption of the client that when the need arises he will be able to have payment coming from insurance company.
We need the change in thinking at all levels.
Health Insurance as % of non life insurance portfolio = 32%
Group policies issued under Health Insurance portfolio = 50%
Policies issued to Individual/ Families = 50%
It means policies being issued to Individuals/ Families are only 16% of total non life insurance portfolio.
General impression is that claims arising from group policy get paid because they have the bargaining /negotiating power .It means that Individuals/ Families are the worst sufferers as this is the group which is having claims being disallowed.
The question before us is how many of the dissatisfied customers are able to reach the office of Insurance Ombudsman?
64% figure is really a very high figure .Let us try to look at the reasons for this scenario or why it is so?
There are 3 players.
Role of every player is to provide good service to the customer. When the insured has to go in for hospitalization then each one ( Insurance Company /TPA/Health care Provider ) is trying to pass on the buck to other player as if the objective or job description of each one is who can harass the customer most so that he runs away and forgets about claim .
Health care provider says that this insurance company is blacklisted or this TPA is black listed
TPA says that this health care provider is black listed.
Insurance Company says that they are ready to consider the payment of the claim but it will not be on cashless but on reimbursement basis. This defeats the basic assumption of the client that when the need arises he will be able to have payment coming from insurance company.
We need the change in thinking at all levels.
Monday, July 12, 2010
All PSU's will be using common TPA
We had covered in the past that KPMG was appointed by 4 PSU's to advise them about a common TPA with a view to protect their interests.
Yes it is going to happen.It may be 1 TPA to be selected by all of them so that they can give good service to them ( 4 PSu's).As it will be a good business therefore naturally all the instructions of PSU's will be followed.
Let us wait for many things to happen.With big hospitals being deleted - Is it going to be market segmentation where HNI's will start moving to private companies like Max Bupa /Apollo Munich .
Yes it is going to happen.It may be 1 TPA to be selected by all of them so that they can give good service to them ( 4 PSu's).As it will be a good business therefore naturally all the instructions of PSU's will be followed.
Let us wait for many things to happen.With big hospitals being deleted - Is it going to be market segmentation where HNI's will start moving to private companies like Max Bupa /Apollo Munich .
Why the newspapers do not reveal the name of the hospital
The Times of India has carried the following news
"Twenty-eight-year-old Javed Akhtar, who was recently admitted to a private hospital, agrees with the TPAs. Last month, Akhtar, who works with a private firm in Noida, met with a minor accident and was admitted at a city hospital. He gave his cashless policy number to the hospital for necessary approval from the TPA. To his horror, he found that the hospital had applied for a spinal surgery and had got Rs 80,000 cleared from the TPA.
"The doctor never got any diagnostic tests like CT scan etc done. I was not even told about the surgery. They took the approval by forging my signature," alleged Akhtar, who later refused to get operated and got a police complaint registered against the hospital. But as he didn't get operated, the TPA refused to clear the bill. '
The question before us is that if the newspaper has carried the news( we appreciate this ) then why not reveal the name of the hospital so that all the insurance companies and TPA's as well as insured can keep the name of the hospital in mind- whether to go there or not.It will be agreat public service.
"Twenty-eight-year-old Javed Akhtar, who was recently admitted to a private hospital, agrees with the TPAs. Last month, Akhtar, who works with a private firm in Noida, met with a minor accident and was admitted at a city hospital. He gave his cashless policy number to the hospital for necessary approval from the TPA. To his horror, he found that the hospital had applied for a spinal surgery and had got Rs 80,000 cleared from the TPA.
"The doctor never got any diagnostic tests like CT scan etc done. I was not even told about the surgery. They took the approval by forging my signature," alleged Akhtar, who later refused to get operated and got a police complaint registered against the hospital. But as he didn't get operated, the TPA refused to clear the bill. '
The question before us is that if the newspaper has carried the news( we appreciate this ) then why not reveal the name of the hospital so that all the insurance companies and TPA's as well as insured can keep the name of the hospital in mind- whether to go there or not.It will be agreat public service.
Tuesday, May 6, 2008
Are Indian Pvt health Insurers blocking payouts ?
The Economic Times of May 6,2008 has carried part of the report released by USAID .The contents are ;
INDIAN health insurance is growing by 25% every year, it’s penetration is less than 0.02% of the GDP, yet there is no expertise on the sector, says USAID report.
The report, released on Monday, to study the impact of private life insurance on health coverage in India has said that the focus in India is on controlling claims pay-out by following strategies designed to minimise insured person’s ability to collect claims. “There is excessive emphasis on disqualification because of pre-existing conditions and post-claim underwriting”, it said. No wonder then, that it is one of the largest litigation areas for insurers. The report has suggested a slew of measures to improve the regulatory framework for health insurance.
For the regulator, Insurance Regulatory and Development Authority (IRDA), the report has a separate prescription for health insurance. Separate reserving rules should be considered for the different categories of health insurance, taking into account the short-term versus long-term nature of contracts, whether policies provide indemnity or assured benefits and the loss experience of varying health insurance products.
It has also asked IRDA to promulgate specific regulations for the sector. These include a minimum regulatory definition of pre-existing illness or condition to provide clarity in interpretation spelling out maximum “look-back” and “look-forward” periods. Further regulation is need to prohibit post-claims underwriting, making it mandatory for insurers to offer both group and individual policies among others.
Taking into account medical inflation, the report called for higher public health care spending. Effective primary care and prevention, safe maternity care and chronic disease management should be a part of public and private insurance, it said. “The burden of disease as measured by Disability Adjusted Life-Years could be reduced significantly if both health insurance coverage and publicly provided care included these services,” it said.
The country has a dismal record of even hospitalisation coverage – the basis for health insurance, it said. Quoting a recent census, it said only 1.7% of admissions were reimbursed and the average reimbursement was only Rs 258 (or 3.6% of the average hospitalisation cost of Rs 6,225).
Private insurers’ administrative cost are 40% of total premiums, double the target benchmark of 20%. Policy holders pay higher charges for healthcare services than those without insurance, because the mediclaim product has been modified in ways that make it less a program to control the cost of care and more a reimbursement target for providers.
The report forsees a more dynamic TPA market going forward, where TPAs could partner with insurer organizations. To encourage competition, it is recommended that mutual insurance companies and non-profit companies should be allowed to enter the market. Although IRDA can retain licensing TPAs, parts of regulation of TPAs should gradually come under the contractual relationships that insurers have with TPAs.
Our comments are;
We as an industry lack innovativeness.When an insurance co wants to develop a product they simply see the products of other co’s and try to copy the same.We suggest they should look at products from around the world and then come out with product.
INDIAN health insurance is growing by 25% every year, it’s penetration is less than 0.02% of the GDP, yet there is no expertise on the sector, says USAID report.
The report, released on Monday, to study the impact of private life insurance on health coverage in India has said that the focus in India is on controlling claims pay-out by following strategies designed to minimise insured person’s ability to collect claims. “There is excessive emphasis on disqualification because of pre-existing conditions and post-claim underwriting”, it said. No wonder then, that it is one of the largest litigation areas for insurers. The report has suggested a slew of measures to improve the regulatory framework for health insurance.
For the regulator, Insurance Regulatory and Development Authority (IRDA), the report has a separate prescription for health insurance. Separate reserving rules should be considered for the different categories of health insurance, taking into account the short-term versus long-term nature of contracts, whether policies provide indemnity or assured benefits and the loss experience of varying health insurance products.
It has also asked IRDA to promulgate specific regulations for the sector. These include a minimum regulatory definition of pre-existing illness or condition to provide clarity in interpretation spelling out maximum “look-back” and “look-forward” periods. Further regulation is need to prohibit post-claims underwriting, making it mandatory for insurers to offer both group and individual policies among others.
Taking into account medical inflation, the report called for higher public health care spending. Effective primary care and prevention, safe maternity care and chronic disease management should be a part of public and private insurance, it said. “The burden of disease as measured by Disability Adjusted Life-Years could be reduced significantly if both health insurance coverage and publicly provided care included these services,” it said.
The country has a dismal record of even hospitalisation coverage – the basis for health insurance, it said. Quoting a recent census, it said only 1.7% of admissions were reimbursed and the average reimbursement was only Rs 258 (or 3.6% of the average hospitalisation cost of Rs 6,225).
Private insurers’ administrative cost are 40% of total premiums, double the target benchmark of 20%. Policy holders pay higher charges for healthcare services than those without insurance, because the mediclaim product has been modified in ways that make it less a program to control the cost of care and more a reimbursement target for providers.
The report forsees a more dynamic TPA market going forward, where TPAs could partner with insurer organizations. To encourage competition, it is recommended that mutual insurance companies and non-profit companies should be allowed to enter the market. Although IRDA can retain licensing TPAs, parts of regulation of TPAs should gradually come under the contractual relationships that insurers have with TPAs.
Our comments are;
We as an industry lack innovativeness.When an insurance co wants to develop a product they simply see the products of other co’s and try to copy the same.We suggest they should look at products from around the world and then come out with product.
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