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Interview of Dr Nayan Shah, Managing
Director, Paramount Health Services
Paramount Health Services, in a joint venture with
Munich Re is one of the licenced third party administrators
and is all set to take the plunge into servicing Mediclaim
policyholders. In a chat Dr Nayan Shah, Managing Director,
Paramount Health Services reveals what cashless hospitalisation
is all about and how soon it will happen.
How soon will cashless hospitalization happen?
Cashless hospitalization may take about two to three months
because there are a number of grey areas that need to be looked
into.
Will Mediclaim policyholders be able to flash their I-cards
and get admission into hospitals as reports state?
No. It may not be that easy. Mediclaim policyholders will
not be able to flash their identity cards and walk-in because
they will firstly need to obtain a pre-authorisation letter
from the insurer. In other words a letter of guarantee of
payment. As a third party administrator (TPA) we will have
to verify whether the person is covered for the respective
illness or disease he has been suffering from and for which
he has come for treatment. And in case of emergencies they
may perhaps have to pay a deposit till the letter of guarantee
is received.
What are the issues that need to be sorted out to enable
cashless hospitalization?
Firstly before administering any kind of treatment we will
need information on what are the illnesses the policyholder
has been covered for. And for this the policyholder will have
to get a pre-authorisation letter from the insurer after which
on the basis of his coverage, he will receive treatment the
payment of which will be made by us - in other words cashless
hospitalization for the policyholder. Otherwise how will we
at our end know what exactly the individual has been covered
for and what are the facilities he can avail of?
With cashless hospitalization will claims come down?
No. Instead it may go up if the finer points are not sorted
out. For instance the policyholder irrespective of the size
of his policy would want to go for treatment in the best hospital
around. And when it comes to room tariff too it will be difficult
to place bars on the insured's choices since the Mediclaim
contract does not specify such details. And medico legally
a TPA cannot interfere in the administration of services.
No TPA wants to enter a loss making business. And public
sector insurers cannot expect TPAs to provide a 24 hour toll
free line, and various other facilities for a paltry fee.
And if there are companies that have agreed to provide the
same they perhaps will resort to certain other unethical practices.
With such realities how can public sector insurers expect
claims to come down?
Have you already tied up with insurers?
Yes. We have tied up with Iffco Tokio, Reliance General Insurance,
ICICI Lombard General Insurance and Bajaj Allianz General
Insurance.
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