“We will be issuing a Request for Proposal (RFP) shortly. Our requirements will be specified in the RFP so that interested parties can submit their proposals,” New India Assurance Chairman and Managing Director M Ramadoss told IANS over phone from Mumbai. Consulting firm KPMG had given a report on the feasibility of setting up a common TPA by the four companies a year ago.
The four insurers, which together do around Rs 6,000 crore of health insurance business selling several lakhs of policies, are not happy with the manner in which claims are being processed and settled by the existing TPAs.
The earlier expectations of TPAs trying to bring down the treatment costs by hard negotiations with the hospitals have not materialised.
On the other hand, insurers complain about diversion of float funds provided to TPAs to other group ventures rather than using those for settling claims. With their claims ratio ruling around 115 per cent, the four insurers are focusing on ways to minimise the claims’ outgo.
Delisting hospitals
One such measure that is drawing flak is the delisting some hospitals where the policyholders can avail cashless treatment - hospitals will directly bill the TPAs or the insurers.
The decision was taken after a detailed investigation by the insurers on over charging by many corporate hospitals. “We took the decision after a year-long investigation,” said Ramadoss. “We have documentary proof on hospitals charging differential rates — higher for those with a policy and lower for others,” he said.
Hospitals also charge differential rates for diagnostic tests based on the kind of room a patient opts for.
According to him, the revised rates that have been negotiated with some of the hospitals do not vary much from their earlier ones. “It should be remembered that higher the claims ratio, insurers will be forced to hike their premium rates,” added another official.
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