Articles

In the past few months, health insurance has been capturing headlines across news platforms. This was because of the removal of several hospitals from the cashless network by public sector insurance companies. The primary reason behind this, as we understand, is the failure to reach an agreement on rates to be charged between insurers and hospitals.

The size of the hospital bill is related to the services provided. An insurer should not be concerned with that. Cost containment in a health insurance company is achieved through a combination of risk adequate pricing, sound underwriting and strong claims management. It is important to have controls in place to manage fraud and abuse. Cashless facility is a positive feature in health insurance policies and aids policyholders to avail of healthcare facilities when the need arises. It not only takes care of the emergency needs for finance but also takes the hassle out of the process of hospitalisation. We strongly believe the cashless facility is here to stay. The current imbroglio is for a short period and status quo will be restored in a short while.

It is important to ensure that the right services are rendered at the right price. The industry should put customers first, and must not compromise on services rendered to them in any way. I have no doubt that there are hundreds of health insurance policyholders in the country who have considered switching their policies to another provider after the current imbroglio over cashless hospitalisation. We believe, switching policies merely for the cashless facility does not make logical sense, unless one wants to also add or change the policy itself.

Before taking such a step the policyholder must ensure that a thorough check on the portability of the new product has been done. Policyholders may have to undergo a fresh waiting period which they had already completed as most insurance companies still do not have complete portability for competitor's products. It is always advisable to decide early and make the decision before the existing policy expires.

During the past decade, TPAs have played a very important role to enable a higher degree of customer service and we believe they have a distinct role in the future. They should be treated as a department within an insurance company and should follow the same procedures. The best way to do that is to position one's staff in the TPA infrastructure and monitor, train and develop the standards of customer service. Many insurance companies are inclined towards the option of having inhouse TPAs. Having an in-house setup or a TPA is by itself no indicator of service quality. What is important is how strong the processes and systems are, and how well they are monitored and controlled.

Source :By Antony Jacob CEO, Apollo Munich Health Insurance