Agreement Between TPA and Insurance Co Must be Disclosed

The Central Information Commission (CIC) has asked public sector health insurance companies to disclose their agreement with third party administrators (TPAs) and hospitals, in order to ensure transparency in delivery of medical services. The Commission rejected the arguments put forth by Oriental Insurance Company that the agreements are between the Third Party Administrators (TPA), to whom the processing of claims is outsourced by the insurance companies, and the hospitals and since the TPAs are not public authority, there is no obligation to disclose these agreements.

Information Commissioner Deepak Sandhu held that funds for implementation of health insurance policies is paid by the respondent (Oriental Insurance) which is collected as premium from its customers.

"Therefore this argument is without merit," she said directing the company to disclose the information. However, the Information Commissioner agreed that some portions of these agreements could be severed as it could adversely affect commercial interests of the company.

Sandhu was hearing the plea of an RTI applicant who had sought information from Oriental Insurance on the issue and list of hospitals across the country which provide cashless treatments facilities.

“The disclosed portions would serve to provide greater transparency in respect of the medical services to which the insured are entitled and therefore lend itself to better service been provided to the insured," Sandhu held in her order and also directed the company to place on its web site the names of hospitals which provide cashless treatments.

Source-Medindia