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Insurance Companies Working on Measures to Speed Up Health Policy Claims
November 29, 2007 at 6:12 PM
Health Insurance News
M. Ramadoss, chairman-cum-managing director, Oriental Insurance Co Ltd, told IANS: "We are also looking at such measures to improve our customer satisfaction levels."
According to an official of Kolkata-based National Insurance Co Ltd, who requested anonymity, said: "Officials of Bank of America have made a presentation to us as to how they are operating the system in UI."
The non-life insurer is in talks with other banks as well to get a good deal.
Interestingly, the Life Insurance Corp of India (LIC), which is entering the health insurance segment, has a similar arrangement with select banks.
TPAs are the entities to which non-life insurers outsource their healthcare claims processing activity.
The main USP (unique selling proposition) of TPAs is that they enable cashless treatment for policyholders. It means a healthcare policyholder can get in and out of hospitals without paying any money, provided the ailment and the total bill falls within the purview of the policy.
For those policyholders who do not avail themselves of the cashless facility can send their claim papers to the TPAs for reimbursement.
The TPAs get 5.5 percent of the total premium as their fee.
In order to facilitate claims settlement, and cashless reimbursement, non-life insurers provide TPAs with necessary funds.
According to an industry official, TPAs prepare cheques in the name of policyholders or hospitals and claim funds from the insurer.
When it comes to the number of cashless settlement claims the experiences of the non-life insurers vary.
In the case of Oriental Insurance and UI, a majority of the healthcare claims are settled under the cashless mode, while National Insurance officials say the figure in their case is less than 50 percent.
Although the government insurers have non-TPA serviced mediclaim policy, they are not offered to policyholders, citing lack of manpower to process claims at their end.
The insurers are also pruning the list of TPAs for better supervision and control.
The general insurers agree that it would take them more time to follow the auto industry's two-vendor policy so that the TPAs are assured of volumes and can scale up their expertise and operations.
Source-IANS
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More News on: Third Party Administrators for Health Insurance, Star Health and Allied Insurance, Health Insurance Policies offered by Bajaj Allianz Insurance, ICICI Lombard General Insurance Company Limited, Health Insurance, Health Insurance - Ombudsman, Health Insurance - Basics, New India Assurance Policies, Awareness about Healthcare Insurance in India, Premium Calculation by Health Insurance Companies
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