Deception in Mediclaim

The headlines  in the Times of India dated today said  that many hospitals are off the Mediclaim radar as many are supposedly involved in false claims.There are related reports about increase in consumer cases because of rejected Mediclaims &Hospital  charges being too exorbitant.

The insurance companies have resorted to denial of cashless facility. All this has led to a lot of hardships for the patients .Obviously after the fleecing by hospitals & TPAs,insurance companies have become bereft of cash - so cashless has suddenly got a new meaning ,for the Insurance Industry that is !

It has been reported that Hospitals have indulged in putting up fraud claims in collusion with TPAs ( Third Party Administrators)  to whom processing of  health related claims has been outsourced by the Insurance Companies.Patients are also said to be  a party to the frauds.TPAs are a recent phenomena unlike hospitals which have been in existence much before.TPAs came in, when the Public Sector Insurance Companies announced the VRS ( Voluntary Retirement Scheme) some years back.The staff shortage due to VRS was tackled by outsourcing processing of health related claims to TPAs.

But the Insurance Companies seem to think that TPAs are doing a good job.Hence,the axe has fallen on the Hospitals. This is not to say that Hospitals are clean but to question this blacklisting of Hospitals.The TPAs ought to be taken to task .But instead of that, a TPA has investigated & based on that investigation ,Hospitals have been listed out.This is giving new meaning to the term " natural justice." Natural justice demands that no one should be a judge in his own case.In this instance,a TPA is the investigating agency & based on that ,so many are blacklisted.How can a TPA sit in judgement on other TPAs as also Hospitals ? The report omits to state if any TPAs have been blacklisted but still,this is all an eye wash.

What are the credentials of the TPA which investigated the fraud claims ? The said TPA is a later entrant compared to some  TPAs .As happens sooner than later,the said TPA may be involved in bigger frauds or maybe get involved later.Perhaps, it wants a clean slate to begin.After all,aren't we  too familiar with the brands which worked hard to get the  ISI marks & once,they got it,it has just been downhill ever since.

The report also says that many Hospitals are in the dark about their status & some Hospitals have themselves opted out of the list due to strict norms.The insurance industry will soon inform its decision to the listed Hospitals but " soon" in Public Sector parlance can range from days to months to years ! So ,the stage is set for disputes about Hospitalisation in blacklisted hospitals as neither the TPA,nor the patient or the Hospital knows the current status of the Hospital.

Related reports speak about the rising number of consumer disputes about Mediclaim.About two thirds of all Insurance claims end up in consumer forums.This is a very sorry state of affairs.Claims are rejected for flimsy reasons like pre-existing ailments,excluded diseases,etal.Moreover,in Public Sector,decisions ( if any ) to delay & reject claims are lauded .Such actions also keep the bosses in good books of the audit & vigilance departments.The executives are preventing the drain of wealth thereby protecting the funds.But when the judgement comes,generally interest payment is also a condition But such small things do keep happening in big Public Sector companies.So,no one gets wiser.

It has been stated in the  report that one can choose the TPA.But this is easier said than done.Many compnaies have only some TPAs on their rolls.So this may not be economical .Moreover,if I want a particular TPA,it may be taken to mean that I want to conspire with the TPA to defraud the Insurance Company.Moreover,how does one know if any TPA is good ,bad or ugly ? Many will tell you that all TPAs are chips of the same block.

Mediclaim is a drain & has been so for a long time.With the TPAs in it now,it has started burning huge holes in the pockets of the  Insurance Companies. So what is the way out ?

One way is to start in house TPA cells manned by the employees of the Insurance Companies .Some private sector companies have set up such cells for processing Mediclaims.The TPAs should be strictly monitored as well, as before the TPAs came in,there were no such blatant attempts at cheating.Unfortunately,the TOI report seems to suggest that TPAs or rather the investigator TPA is calling the shots ! The said TPA Manager has spoken to the press & the Insurance Companies have no spokesperson to tell about their version /s  ! One really wonders " Who is the boss -the TPA /s or the Insurance Companies ? The more things change,the more they remain the same or perhaps change for the worse.On second thoughts,we haven't yet hit the pits ,not yet !

Undertime !

I learnt a new word today -undertime.It means  time spent by an employee on leisure during working hours .Now,when I say leisure, I mean like a person chatting on phone,surfing the net ,typing personal letters,going shopping,etc -all during office hours.Yes,of course one can debate that the phone chat was official,net surfing was also official & so on .The  only characteristic, that makes the said activity official, is that, it was done during the course of employment,nothing more.


Some people are very disciplined.They are the earliest to arrive in office & then they start their long phone chats.But then, this is not undertime,isn't it.Yes,it is not, till it continues  before the office timings but, if the chatting continues after the office timings have started,it becomes undertime.Which is what usually happens- obviously on office phones,the calls are pretty long as office is footing the stupendous bill or bills.There are others who stay back after office hours to chat on phone.Sometimes,they even get paid for overtime- for  working overtime on the phone !

I initially worked in an office in a moffusil area.Some computers were shifted to our branch offices for easing data entry work.This, in turn, led to the transfer of a data entry operator to the branch.He would very sincerely do his work but beyond that,he refused to do any other work even if he was sitting idle.On Fridays,there would be load shedding & hence the data entry operator would just sit & stare at others  .Our requests to him to make himself useful would elicit responses like," My salary makes it unaffordable for me to do any other work other than data entry." His colleagues would just stare at him with jealousy & lament their  fate that they had to continue working whilst he lazed away.

Once,I had picked up some vegetables on my way to office.It was a Friday & the power went off.The data entry operator took my jhola containing the vegetables & started cleaning the veggies.I begged him to do some other office work but he continued with his undertime.He also quipped, that if any executives came for a surprise visit, he would tell then that his boss ( me ) had ordered him to do the cleaning ! Thankfully,nobody came & I was spared the undue explanations about the supposed official undertiming by the employee.Obviously,I was glad that my veggies had got cleaned at office expense during undertrime of an employee but not myself ! This was a double whammy ! I had more time for rest- at home,that is .

In the suburban office,the man Friday, in office, was notorious for being absent for hours together.He would go to bank to deposit the day's collection & on the way back,he would be undertiming.He would even have a haircut by undertiming .He was of the firm opinion, that he had a license to undertime as he worked so hard -for the Company ,that is ! But all this led to his doing overtime till late nights as work was always pending for reasons which were there for all to see.

On one occasion,all male employees went to enjoy an extended lunch which went on for nearly three hours ! They were undertiming en masse ! This can be coined male bonding nah undertiming.But then ,men always complain about females bonding about everything except work.Maybe, this male group undertiming is an exception -one too many !

So,you can understand that overtime & undertime are opposites  in one sense but similar  in another sense.The meanings of the words are opposite to each other.They are both, the same in a way, as both lead to a drain on the employer.In fact,undertiming is the cause why overtime becomes a necessity !

The absence of undertime would have robbed employees of the gold mine of overtime ! So both need each other or better still, thrive in the presence of each other !

Expiry date.

A day before, my brother took out an ice cream box from the freezer & exclaimed," Why is this ice-cream just like that- only little has been eaten." My bhabhi immediately said,"I think,we better not eat it as it is months since we got it."My brother examined the expiry date & was relieved to note that it was past one month only since the expiry date.It was sitaphal ice cream( custard apple ice-cream)

I ,my brother & dad were for consuming the ice -cream.We have a middle class fixation of consuming eatables only after the expiry date is over.Moreover if the eatable is thrown away only because of the fact that it is beyond the date of consumption,then it is a drain on our pockets & since we cannot allow that ,we eat it up.It will affect our well being which will eventually lead to a hole nah many holes in our pockets as we visit doctors never bothers us at all.

My bhabhi & mom were totally against consuming the contents of the box but the majority nah the financially viable option prevailed & we all ate it up.My bhabhi also ate it as she opined that she was guilty for not using it up in time.Thankfully,nothing happened the next day -with our digestive systems that is.Just goes to show that we Indian middle class can digest anything be it food beyond the expiry date,corruption at every level,insults,et al.Really,we have a stupendous mental & phyiscal ability to endure anything & everything.

As we sat eating the ice cream,my brother bit on a seed of custard apple & he exclaimed,"This seed proves that this is sitaphal icecream- just in case you all were skeptical about the claims by the manufacturer" He opined,"We do not come with an expiry date."I quipped,"Of course not,God has stamped an expiry date on us also but we do not know about it."Moreover by some of our rash & negligent actions,we prepone the expiry date.But there are some wise people who are able to postpone the same by means of exercise,diet,meditation,yoga etal.