Insurance company admits to delayed payments to hospitals

Major public sector insurer admits that a few local offices have been delinquent, and a few TPAs have been slack in releasing insured amounts

For a long time, hospitals and doctors have argued that when it comes to payment of the cost incurred on medical procedures, insurance companies don't pay hospitals on time. A major public sector insurance company has admitted to these charges and confirms that some of its regional offices and a few Third Party Administrators (TPAs) may have made delayed payments to hospitals.

"We are addressing these issues. There have been some regional offices that are delinquent, resulting in slackness in payments, while some TPAs have been indifferent when it comes paying doctors on time," said M Ramadoss, managing director, New India Assurance.

Delayed payments have been a major issue with hospitals, who have been complaining that they have been getting their dues after nearly six to eight months. Hospitals have been blaming TPAs for these delays, saying that the intermediaries keep the float given by insurers and delay payments. Even insurers have complained that TPAs are not using these funds to settle patients' claims.

Generally, insurance companies maintain a float with a particular TPA for a period of 15 to 30 days for settling claims. When the float is exhausted, the TPA receives additional money from the insurance companies for settling claims.

However, a few private insurers whom we spoke to said that TPAs can't be wholly blamed for the current imbroglio, as payments to hospitals depend on the insurance company. "The TPAs are being slapped from both sides, they can't do much as the payments depend on us," an insurer told Moneylife, preferring anonymity. These insurers also feel that hospitals were over-charging customers.

Insurers who have done away with TPAs say that they are not satisfied with these middlemen in the process. "TPAs have not been able to live up to the service standards that had been expected from them when these administrators were introduced. This has led to various issues, including some doctors and hospitals refusing to work with them. For us, as an insurer, it would be better if we have our own team which can interact both with customers and hospitals directly, to ensure that our clients are getting prompt service. This will help us to address customer issues much faster," KG Krishnamoorthy Rao, Future Generali India's managing director and chief operating officer, had earlier told Moneylife.

However, Mr Ramadoss says that even hospitals need to be partially blamed. Most cashless claims are preauthorised for a certain coverage amount. Hospitals call the TPAs or insurer to confirm the go-ahead for the operation for the said amount. However, if there is any increase in cost, the hospital doesn't consult the TPA or insurer. So at the time of payment, the TPA or insurer is only able to pay the hospital the said amount and not the additional cost incurred. However, the remaining payment is given out after negotiations between the doctors and TPAs or insurer.

Fee charges and payments have been a topic of intense discussion between insurance companies and hospitals. In fact, in the middle of February, policyholders who were admitted to Mumbai hospitals were trapped in the midst of a raging battle between city-based doctors and TPAs, due to various doctors being unhappy with the low consultancy fees being allowed by a few TPAs for reimbursement, under a number of medical insurance plans.

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COMMENTS

samar mahapatra

6 years ago

Since long heath insurers are having an adversarial relationship with TPA,, thanks to inadequate supervisory role of the IRDA.Use of multiple TPAs and business rivalry has led un business like practice dealing with policy holders/hospitals.A good system brought from western market , has been given a bad name , by step motherly treatment to the beneficial system.We know, what it is dealing with giant insurance co by individuals.

ASCI upholds CERS complaint against ‘Sri Bhagwathy Madom Fitness Massage Oil’, ‘Fat Free Tablet’

The advertising self-regulatory body, ASCI, has upheld complaints against Sri Bhagwathy Madom Fitness Massage Oil and Fat Free Tablet advertisements, after receiving a complaint from CERS

The Advertising Standards Council of India (ASCI) has upheld a complaint from the Consumer Education and Research Society (CERS) against the advertisements of 'Sri Bhagwathy Madom Fitness Massage Oil' and 'Fat Free Tablet' published in various sections of the press.

In March 2010, CERS had complained to ASCI against the claims made in these advertisements. According to the advertisement, Fat Free Tablet is 'scientifically proven' to reduce excess fat and cholesterol, and by using 'Sri Bhagwathy Madom Fitness Massage Oil' one can get rid of loose fat, wrinkles, bulgings, swellings, dry skin, excess sweating and bad odour.

"'Use 'Fat Free Tablet' and 'Sri Bhagwathy Madom Fitness Massage Oil' together and see the magical result within one month'," the press advertisement claimed.

ASCI's Consumer Complaints Council (CCC) found the advertisement contravened Chapter 1.1 of its code. As per the code, 'Advertisements must be truthful. All descriptions, claims and comparisons which relate to matters of objectivity ascertainable facts should be capable of substantiation'.

ASCI has asked the advertiser to withdraw its advertisement. After considering the clinical data submitted by the advertiser, CCC has concluded that the claims mentioned in the advertisement are not substantiated adequately.

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New inflation index from August: Industry secretary

As the WPI gets broadbased, the inflation based on it might even go up further from the annual 10.55% for June

The government will, from August, introduce a new system of inflation measurement that would cover price changes of about 250 extra items, reports PTI quoting industry secretary R P Singh.

"We are ready with the new index now. Most probably, from next month we will start," Mr Singh said, adding that it would be approved by the Committee of Secretaries, headed by the cabinet secretary.

The present monthly inflation measurement system, based on the wholesale price index (WPI), reflects the price variations of 435 items.

"The number of commodities has gone up to something like 670... Weights are accordingly arranged. This will become more reflective of inflation," Mr Singh said. He said the new index has been vetted by experts, and the results were found to be "quite consistent".  

As the WPI gets broadbased, the inflation based on it might even go up further from the annual 10.55% for June.   

The new index is likely to include a host of new products, including consumer goods such as mobile phones and liquid crystal display (LCD) televisions. 

Outdated items such as typewriters and video cassette recorders (VCRs) would not find a place in the new inflation measurement mechanism.  

The base year of the new index would also be changed from 1993-94 to 2004-05.   

The new index is expected to give a more realistic picture of the price rise and its impact on the people.

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