#Medicalnsurance thread.
About 2 decades back very few pts had medical insurance cover. Those who had used to pay hospital upfront & then claim reimbursement.
A change started ~ 2 decades back when third party administrator (TPA) started coming into picture as the mediators.
About 2 decades back very few pts had medical insurance cover. Those who had used to pay hospital upfront & then claim reimbursement.
A change started ~ 2 decades back when third party administrator (TPA) started coming into picture as the mediators.
The TPA's acted as agents between the patient, hospital & insurance companies. Hospitals signed "cashless" agreement with them to provide services to pts. The estimate would be evaluated & cleared by TPA. Denial of cashless treatment is not denial of insurance. TPA's proliferated
Insurance companies wanted to control cost of treatment at hospital. As their customer base increased, they had more power to negotiate. Govt insurance companies which had ~ > 70 % Mediclaim business,made a cartel called #GIPSA which made low cost package for many procedures.
Over a period it became obvious that lot of claims get rejected on flimsy grounds. There are delays in approvals, payments, increase in deductibles, cap on implants, room rate, surgery package etc which has soured the medical insurance benefactor experience in hospitals.
Since hospitals & often doctor are at the front end of exposure to patients - all their frustration, exasperation & anger at insurance issues get directed on to them. Approval & clearance of bills take long time & insurance companies often unilaterally change terms & condition
Now patients think of "Cashless treatment" as a right & not service. They fight with hospital authority for every delay or deduction. Many don't want to spend even a penny extra.
This leaves all parties dissatisfied - pts, hospitals & Doctors who have to give long explanations
This leaves all parties dissatisfied - pts, hospitals & Doctors who have to give long explanations
Some insurance companies have made unreasonably low packages making it difficult to provide good treatment at that cost. This is irrespective of the amount/ duration of insurance that a person may have. Eg - Recently the court removed the capping on lens cost for cataract
Consumer's need to be aware & educated when they take #MedicalPolicy. See what is not getting covered, don't give false information (many don't reveal about high BP or Diabetes), know about room rate capping, co-payments & deductibles. Many of these are written in fine print
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