Sunday, 1 February 2015

The insurance claim should not insist on intra venous line for admission: IMA

In a letter written to the Shri. T. S. Vijayan, Chairman  Insurance Regulatory and Development Authority of India, Indian Medical Association has asked the IRDA to intervene in many aspects as the current policies are injurious to the health of community.

Writing to the regulatory body, Recipient of Padma Shri Dr A Marthanda Pillai, National President and Recipient of Padma Shri, Dr B C Roy National Award and National Science Communication Award, Dr K K Aggarwal, Honorary Secretary General, Indian Medical Association said that " insurance claims often insist on 24 hours admission.  " The duration should be decided by the team of doctors and not the policy. Shorter the duration less will be the chances of hospital acquired infection and readmission rates. Infect there should be bonus if the admission is short and re admission rates are lower."

The insurance claim should not insist on intra venous line for admission. Most of the time the cash facilities are denied if the doctors have not used IV lines.  Doctors are forced sometimes to give IV drugs which is against the WHO policy of safe syringe practices. On the other hands bonus should be given for not using UV lines and switching early from IV to oral therapy.

IRDA must prevent delay in post discharge processing which at times can be up to 6 hours. This unnecessary occupies the bed and more chances of hospital acquired infections.

IRDA should not appoint doctors fron non modern systems of medicine to process claims and raising technical questions. It ends up in injustice to the community

IRDA must make sure that no agencies mushroom for getting TPA empanelment. This has started happening. Make sure that there is no brokerage, commission and fees etc. by agents in the process of empanelment.

IRDA must approve all government approved Nursing Homes for cash less empanelment.

 Process of Preferred Network (PN) Hospital is also a sort of brokerage being charged by TPAs as people who are offering more discounts / cut backs are given empanelment.  This is also against medical council of India rules

IRDA must revise GIPSA rates. These were pushed by four insurance companies without going into the costing and needs revision. They have not been revised since 2010 despite escalation on account of increased salaries of staff / nurses and all other establishment charges. Also GIPSA mechanism is not bothered about the quality as they apply the principle of L-1 rates.  GIPSA makes the system non competitive and is highly subsidized in favour of TPA.  GIPSA is not a declared policy and driven by controller i.e. Insurance business. We must follow L-1 rates while matching apple to apple.

TPA companies also need to be tightened up. They do not make payment even after sanctioning or reduce the payment.  They have not been able to put the grievance Redressal system so far. Also TPA does not take into account difference in provisional and final diagnosis.  Based on tests if the final diagnose is different with provisional diagnosis claims are denied altogether even if there is enough supportive documents are there.  This indirectly forces hospitals and doctors to manipulate records which is unethical and illegal.

Finally the claim payments need to be enhanced as the premiums have been revised by 40%

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