Proposals for a three-way pact between the insurance companies, Third Party Administrators (TPA) and the healthcare providers have been rejected outright, even as a fresh Memorandum of Understanding (MoU) is being drafted between the TPAs and the hospitals.
While the existing MoU is only between the TPAs and hospitals/nursing homes, representatives from the Association of Medical Consultants, Bombay Nursing Homes Association and Association of Hospitals among the others, want the insurance companies to be involved as well.
"Our appeal to the insurance companies to be involved mutually in the agreement has been refused outright. Tomorrow if the TPA decides to shut shop and move away, we will be in a major loss as our funds would be gutted," said Dr Pervez Sheikh, secretary, Bombay Nursing Homes Association.
"At such times the insurance companies should come forward and take up the cause, but they have turned away from doing the needful. Currently, we have no choice but to proceed with the existing system," Dr Sheikh added.
Supporting the stand adopted by the insurance companies, SK Mahapatra, secretary, General Insurance Public Sector Association, assured that in no way would the insurance companies be directly associated with consultants.
According to him, TPAs were appointed for the sole purpose of facilitating the functioning between the insurance companies and the hospitals. "If they want to have a tie-up with the insurance companies then they could do that, but they will have to wash their hands off the cashless scheme and refer back to the old scheme and deal directly with the insurance companies."
The other fact that has not received a favourable response from the TPA's and insurance companies is the bill-discounting clause, wherein the doctors could reimburse their amounts directly from the bank instead of waiting for the same from the insurance companies.
"We are in the process of holding talks with ICICI Bank (the only short listed bank) and the TPA and insurance companies regarding the bill-discounting issue. It will take some time for the procedure to materialize," said Dr Sudha Seth, president elect, Association of Medical Consultants.
As per the demands of the consultants, the hospitals and nursing homes should be made to avail of the bill-discounting clause which would enable them to collect their funds faster then the usual waiting period, which usually exceeds a month or so. Usually the process involves awaiting a clearance letter from the TPA, which is then forwarded to the insurance companies for clearance.
The whole process takes quite some time, at times even stretching to several months. But in case of the bank, once the TPA has given the letter of approval, the doctor could approach the bank directly and collect his funds instantly. The bank would later clear the amount from the insurance companies.
Apart from these two clauses, other points have been favourably accepted by the TPA and insurance companies include; 1.Introduce a standard form to be filled by all specialties; 2.Any decision taken by the TPA to be done in consultation with the medical specialty; 3.Levy an interest rate of 12 per cent if the payments were delayed beyond a month; 4.Scrap the commission clause which is highly unethical; 5.Form a new redressal committee and standardization in issuance of authorization letter.
Currently, work is on to redraft the Memorandum of Understanding (MoU), which would be made available very soon, it is learnt.