Doctors are not agreeing with insurance companies, IRDA remains silent

Patients who were hoping to see the deadlock between hospitals and insurers along with TPAs be resolved will have to wait longer, as medical consultants and hospitals alike are not agreeing with their terms

Patients who were hoping that the war between insurance companies, hospitals and Third Party Administrators (TPAs) would end soon are in for disappointment, especially if they have cashless insurance. While patients suffer, the insurance regulator has remained silent.

Meanwhile, medical consultants and smaller hospitals that were also targeted by insurance companies to reduce costs are unwilling to do so. They charge TPAs and insurers of delaying payments. Rajeev Walwakar, president - Association of Medical Consultants (AMC) said, “They (insurance companies) have said that they will not discuss charges with us. So, even we have decided not to be a part of their meetings as they don’t want to listen to us.”

Medical consultants who have signed agreements with insurers, assuring them of payment within 30 days, say that they don't receive their money for two to three months and sometimes not at all. Hospitals also complain that TPAs take 90 days to settle bills, have to be pursued for payments and often do not pay the full amount. Some hospitals claim that they charge more to patients with insurance, because of these delays.

“How can you ask us to lower charges? Consumers need to get the best possible medical facility but that doesn’t mean that healthcare providers’ payments be overlooked,” added Mr Walwakar.

“If the fixed charges are low, it would be very difficult for healthcare providers to provide quality services and treatment,” said Lalit Kapoor, a member of the AMC. Some doctors even allege that TPAs collect payments from insurers and enjoy the float, while delaying payments to hospitals and consultants. In March, around 1,500 nursing homes and doctors under the banner of the AMC decided to boycott TPAs completely. This drastic measure meant that patients in hospitals covered by these TPAs could not avail of cashless facilities, putting them under severe financial strain.

But this is just one side of the story and not entirely true. It is a fact that most hospitals hike tariffs for anyone who has insurance. There are innumerable anecdotes where patients have been able to get hospitals to reduce their charges by almost 50% by claiming they had no insurance. However, in most cases, patients covered by corporate insurance policies couldn’t care less about hospital charges. Consequently, healthcare costs have been galloping in India, especially in the major metros.

Insurance companies also dismiss claims that TPAs are the cause of delay or are enjoying a float. They point out that unnecessary tests and absurd charges by hospitals have made insurance unviable and insurance companies are forced to examine claims with a fine tooth-comb. Ironically, insurers say that although TPAs are not to be blamed, they aren't of much help either, so they are doing away with their services. “TPAs are getting slapped from both sides,” a private insurer who has done away with TPAs said.

Sanjay Datta, head of ICICI Lombard’s health insurance vertical, has been quoted as saying that the insurance companies have decided to restore cashless facilities on a case-to-case basis. It is unclear whether this applies to patients or hospitals. Also, this is no solution for consumers who are paying an insurance premium in the expectation that it will act as a safety net in their time of need. There is now an attempt to initiate a dialogue between insurance companies and other stakeholders. It is important that insurance for healthcare remains a viable business for insurers. This can only happen if hospitals agree to rein in soaring costs, cut out the practice of ordering needless tests and procedures and rework tariff systems to make them more equitable. However, the shortage of high quality medical facilities allows hospitals to call the shots. And until there is better infrastructure available, patients will be the victims of the tussle between hospitals and insurers – if the government does not step in, health insurance costs in India will soon become unaffordable without any improvement in quality of services or better facilities.



kishore sachdev

7 years ago

SEBI Chief has done away with the comissions on mutual fund investments on the pretext of protecting the end clients. There is a conflict going on between SEBI and IRDA for regulating ULIP and protecting the insured. Now when there is a very strong need of help to the people seeking health insurance nobody seems to come forward and help the consumers. So all this while there was only talk of protecting the interest of the insured, but in true terms it seems it was just flexing of muscles to show who is more powerful. WHY DOES SEBI NOT INTERVENE AND ACT BIG BROTHER TO IRDA AND FORCE IT TO PROTECT THE PEOPLE WHO ARE PAYING HUGE PREMIUMS IN THE HOPE OF RECEIVING TIMELY MEDICAL HELP.

Kalra L K

7 years ago

Hospitals and Doctors over extreme charge the Insured patients, that is very true. Due to this the Insurers are helpless and have to release the unethical huge claims, unwillingly, to hospitals.

Patients have to suffer at both hands, hospitals as well as Insurers/TPAs.

Hospitals overcharges them and make them settle the claims before discharge, till it receives the payments from TPA, and refund them later.

Insurers also have the draconian rule that they deduct the %ge from full settled claim to the extent the patient has paid for the higher category room. This means that if patient has paid 30-50% extra for the room charges from their pocket, due to non availability of their required category room, Insurers deduct full 30-50% from their eligible claim amount. That is very draconian rule Insurers have passed. They should deduct only the extra difference charges, eg. doctor's visit charges only. But there is no effect to the charges of pathology and medicines and materials etc. But Insurers/TPA deduct the percentage from the whole claim amount.
Regulator/Govt. should immediately intervene for this technical avoidance of Insurers liability.

I request MONEYLIFE that this point should be clearly reported to Regulator IRDA and help the innocent public to get out of this injustice.

samar mahapatra

7 years ago

There is not much of a protocol difference between a high end and median hospitals.High cost billing does not guarantee better treatment/ medical cure.There are huge margins in health care delivery.All that Insurers/TPA have to ensure is timely payment.Branded hospitals do not want to give up their margin/ scanning their bills.

Nifty futures to be traded on Chicago bourse from 19th July

Under the cross-listing arrangements entered into in March this year, the Nifty has been made available to CME for the creation and listing of US dollar denominated futures contracts for trading on CME

National Stock Exchange (NSE) on Thursday announced that trading in S&P CNX Nifty Futures on Chicago Mercantile Exchange (CME) will start from 19th July, reports PTI.

In March this year, NSE and CME had announced cross-listing arrangements including license agreements covering benchmark indexes for US and Indian equities.

CME will introduce two new contracts designed to access India's market opportunities, E-mini and E-micro Nifty futures.

The contract size of e-mini contracts will be $10 into the value of the Nifty index on that day and the e-micro contracts will be $2 into the value of the Nifty index on NSE on that day, the exchange said in a statement in Mumbai.

Under the cross-listing arrangements, the Nifty that tracks 22 sectors of the Indian economy has been made available to CME for the creation and listing of US dollar denominated futures contracts for trading on CME.

The license to the Nifty 50 from NSE's affiliate India Index Services & Products Ltd. (IISL), which is exclusive to CME group within America and Europe, is in addition to the existing licensing arrangement between Singapore Exchange Limited (SGX) and IISL, the release said.

These contracts will be traded on the CME Globex platform, providing access to participants around the world.

Investors can trade for nearly 23 hours on CME Globex.
"The introduction of the two new contracts will make the Nifty 50 available to a much larger community of traders and investors across various exchanges and time zones. This will also go a long way in realising our vision of making Indian financial products available globally", NSE's managing director and CEO Ravi Narain said.


Citi sells part of mortgage portfolio to Religare for Rs500 crore

Citigroup clarified that it is very much in the home loan business and has just sold a small portion of its loan-book (5%) so that it can lend afresh

Financial services firm Religare Enterprises today said it will acquire a part of Citigroup India's home loan portfolio for Rs500 crore, representing 5% of the latter's total mortgage book, reports PTI.

Citigroup clarified that it is very much in the home loan business and has just sold a small portion of its loan-book so that it can lend afresh. The acquisition would be done through the non-banking finance arm Religare Finvest and is expected to be completed by October.

"We have entered into an agreement to acquire part assets of Citigroup India's mortgage portfolio for Rs500 crore. The deal would be completed in the next three months," Religare Finvest chief executive Kavi Arora told PTI.

He said Religare Finvest has been in the home-loan business for the last three years and the acquisition of key assets of Citi's mortgage business would give it an edge.

The acquisition is the first by Religare Finvest since it started offering loans for SME commercial vehicles and construction equipment in the third quarter of 2008.

Citi South Asia chief financial officer Abhijit Sen said, "This sale is of a small pool of mortgages representing less than 5% of our total mortgage portfolio. Citibank routinely sells small tranches of its portfolio to optimise returns on capital and such assets sold are substituted by fresh loan."

Mortgages are a priority business for Citi and a core part of the bouquet of products and services offered to customers, Mr Arora added.

Citi's total mortgage portfolio is Rs9,000-Rs10,000 crore and its total loan-book is about Rs40,000 crore.

Religare Finvest is a wholly-owned subsidiary of Religare Enterprises and is registered with the RBI as a non-banking finance company (NBFC). It currently provides consumer finance, Initial public offer (IPO) financing and personal financial services. The NBFC is present in 23 cities and employs over 400.


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