While we have been happy with growth of health insurance segment in the recent years, some of the negative points have started appearing. In the conferences recetly attended by me, I heard the following statements:
1. Insured getting policies issued from 3 insurance companies. Went for hospitalization, managed 3 original sets of bills, reports, receipts, discharge summaries. Lodged claims with all the 3 companies.
2. Hospital having 10 rooms had informed the different Insurance companies/TPA�s that 18 rooms are occupied or say 18 patients are being treated. Bogus names/patients/records are being maintained. Someone jokingly commented that even a software has been developed to handle the bogus accounting.
3. When a hospital was black listed by Insurance co or TPA then they shifted the hospital 4 buildings away with different name and again got listed with Insurance co's /TPA.
4. First floor of the hospital was being used for marriages as a Banquet Hall,with a view to take the benefit of heavy/busy marriage season.
Question before us is frauds have to be controlled as these are adding to the losses of the Insurance Companies and will ultimately result in increase in premium rates.
What are the alternatives before us?
Lodging of FIR with Police-question is then what next?Is it a piece of paper only?
Should these be referred to Economic Offences Wing of the Police Dep�t?
Do we have this specialised wing in all the states?
Should there be black list for those inividuals who are indulging in fraud so that for their life time they will not be able to get Health Insurance Policy? Imagine the data base size? Are all insurance companies ready to share the data?
Identification number to be issued by Authority under Nandan Nilekani should be made compulsory for all proposals /health insurance policies to be issued. As this will take time (may be 3 yrs to cover our population) Then why not start using PAN No as the controlling number.
Comments are invited.
Monday, November 9, 2009
Soon we will have SBI General Insurance Company becoming operational
We understand most of the approvals are through for setting up of JV between SBI and IAG of Australia and in the coming months this company will become operational.
In view of the recent good achievements of SBI Life it is foreseen the competition will increase in Non Life Insurance/General Insurance segment.
Extensive coverage of the branches of SBI all over the country will be a good feature of this company.
In view of the recent good achievements of SBI Life it is foreseen the competition will increase in Non Life Insurance/General Insurance segment.
Extensive coverage of the branches of SBI all over the country will be a good feature of this company.
Tuesday, September 22, 2009
TPA�s to deduct TDS when releasing payment to Hospitals
TPA�s (Third Party Administrators) to deduct TDS when releasing payment to Hospitals
Recent news item indicates that this decision is now being implemented.We are not going into details of the same from taxation angle but we feel that the impact of this will be increase in rates by hospitals as they will find it a necessity to increase the rates with a view to handle the increased need for working capital.
The normal inflation of health care in India is 15% per year-should we expect 18% during 2010. Let us wait and watch.
Recent news item indicates that this decision is now being implemented.We are not going into details of the same from taxation angle but we feel that the impact of this will be increase in rates by hospitals as they will find it a necessity to increase the rates with a view to handle the increased need for working capital.
The normal inflation of health care in India is 15% per year-should we expect 18% during 2010. Let us wait and watch.
Medical Mafia Aug 28, 2009 issue of Fortune
It is always a pleasure to read independent articles in publications like Fortune, where an unbiased article can be an eye opener for all of us.
This article is worth reading � where a group comprising of doctors and lawyers handles the cases and fights with Health Insurance company's so that the genuine or inflated claims are made on insurance companies and are also passed.
The team covered in the article manages the best of doctors and they are assisted by lawyers to appear in the courts so that the client gets paid at much higher level. Ofcourse the agreed % out of this payment goes into their (lawyer/doctors) pocket. Question before us is does it happen because Health Insurance co�s in USA are also hesitant in passing of claims?
We do hope that Indian Non Life Insurance co�s as well as Health Insurance co�s will take corrective steps well in advance so that we can avoid excessive role for lawyers to get the claims passed.
This article is worth reading � where a group comprising of doctors and lawyers handles the cases and fights with Health Insurance company's so that the genuine or inflated claims are made on insurance companies and are also passed.
The team covered in the article manages the best of doctors and they are assisted by lawyers to appear in the courts so that the client gets paid at much higher level. Ofcourse the agreed % out of this payment goes into their (lawyer/doctors) pocket. Question before us is does it happen because Health Insurance co�s in USA are also hesitant in passing of claims?
We do hope that Indian Non Life Insurance co�s as well as Health Insurance co�s will take corrective steps well in advance so that we can avoid excessive role for lawyers to get the claims passed.
Monday, August 31, 2009
Medical Cost Contrast (Source Various editions of Hindustan Times Aug 2009)
Medical Cost Contrast (Source Various editions of Hindustan Times Aug 2009)
Many a times we come across question of persons who access our website and want to know about costs associated with various treatments .It is interesting to find some cost contrasts in various editions of Hindustan Times.We have compiled these for your reference so that you can interpret it in the best possible manner.
1- Treatment: Treatment for brain hemorrhage and face reconstructive surgery
Hospital: Apollo Hospital
Cost: Rs.1,22,922 (Including stay in the hospital)
ICU charges: Rs.56,000(per day, including consumables)
Hospital: Government
Cost: Rs.20,000 � 30,000 (including medicine and consumables)
ICU charges: Rs.10,000 (consumables and bed charges, surgery is free
2- Treatment: C-Section
Hospital: Max Hospital (Pitampura)
Cost: Rs.60,000 (Single room)
Hospital: AIIMS
Cost: Surgery (free)(cost of consumables Rs.3000 + Rs.360 for 10 days hospital stay)
3- Treatment: Change of pacemaker
Hospital: Max Hospital (Pitampura)
Cost: Rs.65,000 (Inclusive of 3 day hospital stay + cost of pacemaker and other consumables (Rs.60,000 � 70,000)
Hospital: AIIMS
Cost: Rs.55,000 (cost of pacemaker + Rs.5,000 for procedure)
4- Treatment: Caesarean Section-Delivery
Hospital: Sir Ganga Ram Hospital
Cost: Rs.35,000 � 40,000 (double sharing) Rs.70,000 (single room)
Hospital: Government
Cost: Surgery 0 (free) (consumables and bed charges:Rs.3,000 + Rs.365 for 10 days at AIIMS)
5- Treatment: Left Leg Femur Surgery
Hospital: Sir Ganga Ram Hospital
Cost: Rs.40,000 � 45,000 (two days)
Hospital: Government
Cost: Surgery 0 (free) (cost of implants and medicines(Rs.8000 � Rs.10,000
6- Treatment: Cancer Treatment
Hospital: Rajeev Gandhi Cancer Institute
Cost: Rs.7,00,000 � Rs.8,00,000 (including medicines, bed stay, ICU charges)
Hospital: Government
Cost: Rs.3,00,000 � Rs.4,00,000 (including consumables)
You may find these useful for deciding what should be the sum assured?
Many a times we come across question of persons who access our website and want to know about costs associated with various treatments .It is interesting to find some cost contrasts in various editions of Hindustan Times.We have compiled these for your reference so that you can interpret it in the best possible manner.
1- Treatment: Treatment for brain hemorrhage and face reconstructive surgery
Hospital: Apollo Hospital
Cost: Rs.1,22,922 (Including stay in the hospital)
ICU charges: Rs.56,000(per day, including consumables)
Hospital: Government
Cost: Rs.20,000 � 30,000 (including medicine and consumables)
ICU charges: Rs.10,000 (consumables and bed charges, surgery is free
2- Treatment: C-Section
Hospital: Max Hospital (Pitampura)
Cost: Rs.60,000 (Single room)
Hospital: AIIMS
Cost: Surgery (free)(cost of consumables Rs.3000 + Rs.360 for 10 days hospital stay)
3- Treatment: Change of pacemaker
Hospital: Max Hospital (Pitampura)
Cost: Rs.65,000 (Inclusive of 3 day hospital stay + cost of pacemaker and other consumables (Rs.60,000 � 70,000)
Hospital: AIIMS
Cost: Rs.55,000 (cost of pacemaker + Rs.5,000 for procedure)
4- Treatment: Caesarean Section-Delivery
Hospital: Sir Ganga Ram Hospital
Cost: Rs.35,000 � 40,000 (double sharing) Rs.70,000 (single room)
Hospital: Government
Cost: Surgery 0 (free) (consumables and bed charges:Rs.3,000 + Rs.365 for 10 days at AIIMS)
5- Treatment: Left Leg Femur Surgery
Hospital: Sir Ganga Ram Hospital
Cost: Rs.40,000 � 45,000 (two days)
Hospital: Government
Cost: Surgery 0 (free) (cost of implants and medicines(Rs.8000 � Rs.10,000
6- Treatment: Cancer Treatment
Hospital: Rajeev Gandhi Cancer Institute
Cost: Rs.7,00,000 � Rs.8,00,000 (including medicines, bed stay, ICU charges)
Hospital: Government
Cost: Rs.3,00,000 � Rs.4,00,000 (including consumables)
You may find these useful for deciding what should be the sum assured?
Thursday, August 20, 2009
Liver transplant costs how much?
A common question asked is how much health insurance coverage do I need?
It is a very simple as well as a very difficult question.
Simple -whatever you can afford
Difficult-it should cover whatever treatment you may need during the validity of the policy.
I have come across a news item in HT regarding Priya ,who has undrgone liver transplant in Ganga Ram Hospital in New Delhi.It cost her Rs 22 lakhs.This does not incude the travel costs which she might have incurred as she is resident of Mumbai and decided to get the surgery done in Ganga Ram Hospital.
As covered earlier in my blog the maximum insurance coverage available to any one from few Indian Insurance companies is Rs 10 lakhs ( mostly it is Rs 5 lakhs).Even if some one had taken the policy of Rs 10 lakhs,one would have paid Rs 12 lakhs out of own pocket.Let us come out with policies ,where sum assured can be Rs 25 lakhs.Let us see which company makes the beginning.
It is a very simple as well as a very difficult question.
Simple -whatever you can afford
Difficult-it should cover whatever treatment you may need during the validity of the policy.
I have come across a news item in HT regarding Priya ,who has undrgone liver transplant in Ganga Ram Hospital in New Delhi.It cost her Rs 22 lakhs.This does not incude the travel costs which she might have incurred as she is resident of Mumbai and decided to get the surgery done in Ganga Ram Hospital.
As covered earlier in my blog the maximum insurance coverage available to any one from few Indian Insurance companies is Rs 10 lakhs ( mostly it is Rs 5 lakhs).Even if some one had taken the policy of Rs 10 lakhs,one would have paid Rs 12 lakhs out of own pocket.Let us come out with policies ,where sum assured can be Rs 25 lakhs.Let us see which company makes the beginning.
Insurance Companies to start publishing the financial data
Large number of insurance clients ask us from time to time about the financial health of different insurance companies : As none of the company is listed on the stock ecxchange therefote it was not possible for a common man to find out which company is financially strong or weak .The good time is coming as the Insurance regulator IRDA will make it mandatory for all insurers to disclose their financial statements to the public, even if they are not planning to get listed on stock exchanges.
Disclosures will apply to both public and private insurers and this was announced by Mr. J Harinarayan, Cahirman IRDA in Hyderabad.
The proposed move will bring in transparency and enable policyholders to gauge the financial strength of insurance firms. It will also help potential investors assess the strength of a company as and when the company plans to launch an initial public offering (IPO).
Currently, insurers furnish quarterly statements to IRDA, but as you know this is not in public domain.
Disclosures will apply to both public and private insurers and this was announced by Mr. J Harinarayan, Cahirman IRDA in Hyderabad.
The proposed move will bring in transparency and enable policyholders to gauge the financial strength of insurance firms. It will also help potential investors assess the strength of a company as and when the company plans to launch an initial public offering (IPO).
Currently, insurers furnish quarterly statements to IRDA, but as you know this is not in public domain.
Swine Flu -Is it covered or not?
Insurance companies have come out with some clarifications and these are;
(1) Cost of Tami flu is not covered as this is being given by the Government on free of cost basis.
(2) Private hospitals can charge the patient for facilities like tests, beds and doctors fees. And this will be covered.
(3) If admitted in a hospital and the tests are negative then nothing is payable. If positive then it is payable.
(4) If it is a new policy then 30 days clause is applicable.
Summary of all above mentioned points is that do not wait but get health insurance policy immediately,otherwise be prepared to be treated in one of the government owned hospital.
Wish you best of luck so that you don't get affected with this disease.
(1) Cost of Tami flu is not covered as this is being given by the Government on free of cost basis.
(2) Private hospitals can charge the patient for facilities like tests, beds and doctors fees. And this will be covered.
(3) If admitted in a hospital and the tests are negative then nothing is payable. If positive then it is payable.
(4) If it is a new policy then 30 days clause is applicable.
Summary of all above mentioned points is that do not wait but get health insurance policy immediately,otherwise be prepared to be treated in one of the government owned hospital.
Wish you best of luck so that you don't get affected with this disease.
L&T FIN to own 100% of General Insurance Company
It is good to know that L&T Finance Ltd, a 100% subsidiary of Larsen & Toubro Ltd (L&T), will not be partnering with any foreign entity to float the venture for General Insurance Company
The announcement to foray into general insurance business is expected in the next few months.
The announcement to foray into general insurance business is expected in the next few months.
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