‘Public sector insurers will be launching their own Third Party Administrators’

The CMD of The New India Assurance Co Ltd, M Ramadoss, spoke with Moneylife’s Raj Pradhan and Aaron Rodrigues on various issues facing the insurance industry

Raj Pradhan & Aaron Rodrigues (ML): Can you tell us what the current situation is in the cashless facility imbroglio between public sector insurers and hospitals?

M Ramadoss (MR): Insurance companies have been witnessing inflated, fraudulent, and unwarranted claims from some hospitals when the patient wishes to go for cashless treatment. Due to this, insurer-funded healthcare cost is more than individual funded cost. The reverse is true in developed countries.

We have 380 hospitals who have agreed to be part of our Preferred Provider Network (PPN). Ideally, we want as many hospitals on board as possible. The standard rates could vary based on location, facilities, equipment, etc. It is not one-size-fits-all. If there are industry-standard rates, we will welcome it. Due to the absence of it, I have to step in but not to rob hospitals of their profits. We have benchmarked average costs of prior years and used recommendations of doctors on the panel.

ML: Removal of cashless facilities from major hospitals is causing inconvenience to policyholders. What are your comments?

MR: Out of 100 policies, 8% make claims of which 35% are cashless. It is not a great disservice. If the patient is unable to go to a PPN hospital, the reimbursement will still happen after the claim is submitted. We are technically and legally not violating the agreement with policyholders because we specify in the policy that hospitals have to agree to our terms. I don’t see any harm to our reputation. On the contrary, I have received congratulatory emails for the PPN initiative.

ML: There are reports of public sector insurers coming up with new policies for cashless facilities at high-end hospitals.

MR: We are open to talks with all hospitals and share how we arrived at costing of procedures for different grades of hospitals. Contrary to belief that hospitals are trying to get out of PPN, more hospitals are coming on board. Some of them are prevented from talking with us by different associations, but have indicated willingness to talk in the near future. Unlike in the US, the supply constraint is present in India for quality healthcare which does make it difficult to negotiate with corporate hospitals. We do need discounts on volume of business. If we are unable to convince high-end corporate hospitals to join the PPN, we will be forced to come up with a separate plan for cashless facilities at high-end hospitals. The premium for this ‘Platinum’ policy will be higher, but we have not finalised it. It is at the drawing board stage. We have solidarity from private insurers too. They are also suffering due to erratic charges from some hospitals.

ML: What are some of the checks and balances in the system?

MR: We have ongoing work to check and audit the system. At one time, we did a three-month investigation in different cities. We found cases of bogus nursing homes, bogus bills from hospitals and pharmacists as well as fraudulent claims by policyholders. We would like policyholders to assist us by reporting any aberration to us and to verify hospital bills.

We are moving towards a centralised payment system that will streamline the payment process. We have an external agency to audit all Third Party Administrators’ (TPAs) files. Public sector insurers will be starting our own TPA entity in a year’s time. We have not finalised an outside partner. It may be in-house, but a separate company. It will help to have better control over claims.

ML: It has been reported that public sector insurers want to deal directly with equipment suppliers and pharmaceutical companies to cut claims cost by 20-30%. Are these reports true?

MR: No. The news is not correct as we don’t have any immediate plans of doing so.

User

COMMENTS

MUKESH

7 years ago

I INSURED UNION BANK'S UNION HEALTH MEDICLAIM 3 YRS. AGO - A TIE UP WITH NEW INDIA. NEITHER OF THEM HAVE ANY CUSTOMER CONSIDERATION, WHATSOEVER!

AT RENEWAL TIMES, WE NEVR GET REMINDERS! WE HAVE TO STRUGGLE & CAJOLE THEM TO GET US INSURED - THROUGH UBI! SEVERAL MONTHS (AT LEAST3) AFTER THE RENEWAL DATE WE GET THE MIDICALIM CARD & ACKNOWLEDGEMENT THROUGH OVER A DOZEN REMINDERS TO THEM EVERY WEEK!

EVEN AFTER THAT, WE HAVE NO INFORMATION ON THE DETAILS OF THE POLICY AS THEY NEVER SEND THE POLICY ITSELF EXCEPT DEBITING THE ACCOUNT.

BOTH UBI & NEW INDIA KEEP PASSING THE BUCK TO EACH OTHER SAYING IT IS THE OTHERS' DUTY/RESPONSIBILITY! AND ALSO KEEP BLAMING THE TPA, WHICH IS CHANGED / DIFFERENT EACH YEAR!

FOR 2010, TPA IS A KOLKATA CO., WHICH SENT US A BOOKLET OF KOLKATA HOSPITALS WHILE WE ARE RESIDING IN CHENNAI! AND ALL THE NOS. PRINTED IN THE BOOKLET ARE WRONG OR ANSWERLESS!

IT IS NOW 7+ MONTHS GONE, AND NEITHER UBI, NOR NEW INDIA NOR TPA HAS BOTHERED TO SEND ANY CORRECT INFO. THOUGH WE ASKED UBI SEVERAL TIMES SO FAR!

WITHOUT ANY MEDICALAIM ITSELF, IF THIS IS THE REALITY, IMAGINE AN INSUREERS PLIGHT OF WHAT HELL THEY HAVE TO GO THROUGH IF A CLAIM IS TO BE DONE!

UNIOIN BANK DABBLES INTO ALL KINDS OF BUSINESSES, BUT HAS NO SENSIBILITY AS TO HOW TO DEAL WITH IT NOR DOES IT KNOW HOW TO TAKE CARE OF CUSTOMERS!

WILL ANY 3 OF THEM BOTHER TO RESPOND TO THIS?

MUKESH
94441-27673

NTPC seeks gas assurance for its power stations from power ministry

New Delhi: State-run NTPC has sought assurance from the power ministry to pursue its case to the oil ministry for allocation of 30 million standard cubic metres of gas per day (mmscmd) to fuel the expansion of its gas-based power stations, reports PTI.

"The company has chalked out ambitious expansion plans to enhance its existing gas-based capacity of about 4,000 MW by 2015 and needs assured supply of the liquid fuel.

"We have to ascertain the fuel availability only then can we start the process of expansion...then we can order equipment etc," said NTPC chief managing director R S Sharma.

NTPC plans a gas-based capacity addition of 6,000 MW of its existing power stations at Kawas and Gandhar (Gujarat), Auraiya and Dadri (Uttar Pradesh) and Kayamkulam in Kerala.

For the capacity addition of this magnitude, the company requires 30 mmscmd. One mmscmd is needed for firing a 200 MW gas-based power project.

At present NTPC has seven gas-based stations in different parts of the country—413 MW Anta (Rajasthan), 652 MW Auraiya (Uttar Pradesh), 645 MW Kawas (Gujarat), 817 MW Dadri (Uttar Pradesh), 648 MW Jhanor-Gandhar (Gujarat), 430 MW Faridabad (Haryana) and 350 MW Rajiv Gandhi combined cycle power project at Kayamkulam in Kerala.

NTPC also operates the 1,940 MW Ratnagiri Gas and Private Power Ltd along with GAIL India and Maharashtra State Electricity Board (MSEB).

The company's current fuel requirement is 17 mmscmd, which is likely to rise with increase in the capacity to over 10,000 MW in the next five years.

NTPC has time and again sought gas for the expansion of its projects other than Kawas and Gandhar for which it is fighting a legal battle with Reliance Industries (RIL), from the power ministry.

The company awaits the ministry's assurance for fuel supply and can then go ahead with its augmentation goals.

Meanwhile, NTPC today commissioned the 490 MW unit of the Stage-II of its coal-based power plant at Dadri in Uttar Pradesh, thereby taking its current installed capacity to 32,194 MW from all sources of energy.

User

Stiff upper lip and all that rot

The inside story of the British PM’s visit to India

Ardent readers have complained to me that I am writing too many serious articles for Moneylife, and that now and then there should be some relief, preferably before the weekend. Please understand, I try to find humour in everything, but lately things have been anything but funny across multiple fronts. However, as I advised a similarly woebegone lady friend in Kolkata, I plan to push the chest up and the stomach in, so here goes.

From Delhi, the big news is that the very young and dashing British prime minister visited Bengaluru and Delhi, essentially to pick up a cheque for a few dozen jet trainers, and make the right kind of noises. Place some highly quotable mentions about Pakistan, have lunch with the gin and lime set, and while he flew in on a commercial BA jetliner (a point noted by all), the rest of the gang including almost everybody from every PR company in the world flew in on private jets and blocked off all the best rooms in all the hotels in town. Even AC II-Tier berths on some trains were sold out solid, on the off-chance that the British PM may travel by train, as somebody else had done before.

But first, a short history lesson on the importance of this visit.

It is likely that David Cameron does not remind anybody else but me of Robert Clive, who was less than 50 years old when he completed his takeover of India. When he was young, he set up a protection racket and vandalised merchants who did not pay up. He then trained as a book-keeper, and sailed up the Hooghly into a highly fractured India ruled by a lot of old people, on the eastern and southern side, that was mainly the Nizam and the two Nawabs (Bengal and Avadh). He then sold arms to everybody while raising troops of his own with the money. Whenever Clive was in trouble with anybody, the Mughals would come and bail him out, and meanwhile in the rest of the world and the Coromandel Coast as well as the Malabar Coast and all the way up the Konkan till Aden, the Brits made peace with Europe (France & Company).

Then subsequently Clive moved to the west coast of India, where he took on Kanhoji Angre with the help of some other Marathas. After that he went back to Kolkata with some more Marathas and took the Mughals on. That’s because the Mughals were getting sharp and wanted to invest in the arms trade too. By now everybody in India realised that this was fun, and so they too wanted to do business with the British, so the bankers and the rest of them from the Caliphate of Londonistan took over and started rewarding the local kings and queens and their baby and baba log by rationing out gun salutes and admitting some of them to boarding schools where they learnt how to wear funny hats and were made to feel that the London Fog had been invented for them as a special favour.

After some time, the Americans who wanted to divert the attention of their own coloured people and women, wanted a share too, so they invented democracy for natives. Then Gandhiji came via South Africa and Jinnah came from Gujarat and Netaji Subhash Bose was given the heave-ho and now Cameron seems to have started the whole cycle again.

I learnt this version of Indian history at a very rundown and small bar off the now burnt-out Cutty Sark, where I was also told by somebody who claimed he was an Admiral and had the keys to the secret underground tunnel below the Thames from Greenwich to East India Quays which is where India was really ruled from, and that the Ashoka Lion was a sibling of the British Lion, and that India was lucky it did not get stuck in the other great British Trade Phenomenon — moving slaves known as blackbirds from Africa to America in exchange for gold. This was a good trade, it consisted of everybody calling everybody else a pirate, and then knocking off a few million of the native Americans too. I argued with him saying this was sad, we would have had more Indian origin people in America in that case, no? He then told me about the Last of the Mohicans, so I felt relieved, and went back in a taxi driven by a man who had four wives.

Other interesting aspects of Cameron’s visit to India not covered by the mainstream media, but discussed over rum and tonic water, at a secret location where parking is free:

Lunch at the official reception was pineapple juice, chicken/daal/sabzi, rice and roti, kulfi. Tea/coffee. That’s it.

The head of Barclays Bank was not entertaining complaints from Indian customers of the retail and credit card divisions, since now Barclays is like a government bank.

They will not return the Kohinoor because they don’t feel like it, and also Chagos Island/Diego Garcia, the Amravati railings. Most of what is lying in the British Museum is their birthright.

Terrorism from Pakistani soil was unacceptable, but he did not really condemn terrorism from British soil, because that is their birthright, too. (See above).
 
BBC continues to push Mark Tully who dresses Delhi sensible. The rest of the British media started the day in suit-boot-pant-tie and slowly stripped as the day wore on.
 
There was no discounted platter named after him at Bukhara, not even veggies or chicken tikka.
 
These Brits really have the formula down pat. They want our wealth, for the Crown, but won’t return the Kohinoor. And all this, despite getting names wrong — the PM called Sunil Mittal ‘Bharti Mittal’. Too many Mittals in the British firmament lately?
 
Back to Londonistan, then, the Khalifa awaits, these then are the real secrets of Cameron’s business visit to India. He even blocked off any possible Tipu Sultans by going to Bengaluru first.
 

User

COMMENTS

Roopsingh

7 years ago

Dear Veereshji-i am waiting for your comment regarding points i have indicated-will u please elaborate them in form of a new article so that readers can make more comments....

Roopsingh

7 years ago

Acts of our politicians have already made us laughing stocks in the world-every tiny country has some sort of self respect-but our politicians can go and have their noses rubbed in pakistan-they just want power and money at all cost-they can sell every morality for these things-
its time to remove all such politicians from the drama-let it be done by any-even terrorists are welcome if they can remove these corrupt politicians-

REPLY

V Malik

In Reply to Roopsingh 7 years ago

RoopSingh ji, I would like to state that we have to work within the Constitution and Laws of India to fix the system.

rgds/VM

Roopsingh

In Reply to V Malik 7 years ago

Veeresh ji-do u think consitutuion is something static?and AMAR SATYA?
i feel things have to change to new shapes if they dont serve the purpose-like we sell scrap cars and that new steel gets changed to another new model which is liked more then the scrap model-same way our social /moral/intellectual/economical system needs to be transformed urgently-if we dont-we will remain laughing stocks in the eyes of the world-

Roopsingh

7 years ago

I am very very serious guy as most of people often comment on me-but this article is focused on a very serious matter in a humorous manner-are we indians not capable of making our own aircrafts ?not even helicopters?russians achived atom bomb formula with in 5 years after usa put atom bomb on japan-dont we have such brains?then why we call our selves one of best brains in the world if we cant use it for our defence requirements?i am sure greed and commission/DALALI are major factors to keep this trend of importing outdated defence technology.
just keep on chanting MERA BHARAT MAHAN and lure in dreams .
thats the only way we indians can live a longer life-if we become serious-our life span will get shorten-so laugh on ourselves and our foolish acts and let the world laugh at us-
Thanks regards-ROOPSINGH

Satish Talim

7 years ago

A very good read. Need more such articles, Veeresh.

REPLY

V malik

In Reply to Satish Talim 7 years ago

Dear Satish ji, thank you for your kind words.

rgds/vm

gourish

7 years ago

very good reading after a long time

REPLY

V Malik

In Reply to gourish 7 years ago

Gourish ji, thank you for your kind words.

Regards/Veeresh

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