Monday, July 12, 2010
Friday, July 9, 2010
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 !
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 !
Saturday, July 3, 2010
Thursday, July 1, 2010
Sorry
This is the age of saying Sorry .You must have seen it coming.All over the world,people from all walks of life started saying that they regretted the acts and or omissions committed by them or their ancestors or their countrymen etal in the past.This regret was then given official recognition by the head of the State saying 'SORRY " to the victims and or the survivors or the present day generations whose forefathers had been butchered.
Sorry ,I believe is a very convenient word .Convenient, as anybody commits a felony,an act or ommisssion to wrong another or others knowing it to be grossly unjust & then regrets by saying " Sorry ." Hence,it is the most abused & misused word of the English language.
Recently,the Canadian Prime Minister publicly apologized for being apathetic to the Kanishka tragedy.Now,the present Canadian Prime Minister was not responsible for the accident but he said he was regretful for the attitude of his administration .So ,in this case,someone who is hardly to be blamed takes the blame & expresses regret.Moreover,since it is done publicly & by Head of the State,it is a very strong apology.But do the victims feel that this is so ? Is it that all felonies can be done & then apologized in front of the world & so will be forgiven ?Also,as the government is expressing regret,all ought to be forgiven but is this workable ?Perhaps,this means that the said case or felony is a closed chapter now & all should move ahead.It also means that the victims need not keep harping about the same wrong doing.But naturally,there will be new wrongs which have been committed & will continue & so we must move on to those .
Similarly,the Pope has said that he regretted that children were sexually abused by the clergy in some European nations.The Pope probably means that such acts will not be repeated but how anyone can guarantee this is beyond me as the Pope has refused to bring the perpetrators to book.There is nothing which will debar anybody to repeat such wanton crimes .How are these perpetrators different from other similar accused ? Only that these are from the Church -they enjoy a position of trust & hence the crimes are more grave.What about the victims who have suffered for years & come out openly now to complain ? Just a " Sorry " will never be able to erase all the painful & horrific memories for the victims who were so vulnerable at their tender age.
Come to think of it-if US were to say sorry to Japan for the Hiroshima & Nagasaki attacks, Israel were to say sorry for the acts it keeps indulging in Palestine et al,& so on & so forth,there would be peace .The Nobel Peace Prize would then go to the word " Sorry " ! But since,we have to keep giving Nobel Peace Prizes to so many people so as to appear politically correct,we have to keep indulging in acts of war.Then we can pretend to be making herculean attempts at brokering peace & be the contenders for the coveted prize,if not the winner !
When our Prime Minister went to Canada,he apologised at a meeting about the anti -Sikh riots .The idea behind this was that the Indian PM,himself being a turbanded Sikh,his public apology will carry a lot of weight.But can the Sikhs forget & forgive one of the worst nightmares they have faced ? They have lost so much that one brutualised victim had gone on record to say that they had lost all & had nothing left to loose ! If the ruling party thinks that justice has been done by the PM's public apology,then we need no courts,no judges,etal.All public crimes wherein a large number of people were involved can be settled out of court by saying sorry.Only individual acts & ommissions need to be tried & punished.So convenient-our courts as of now have enough judges to try these individual cases.So much time is wasted in having commissions of enquiry ,committees & sub committtees on fact finding missions.But once we no longer need them, where will our retired but pliable judges,beurocrats,politicians go ? They cannot fade into oblivion like us,lesser mortals.So for their sake,we have to pretend that we are indeed serious about meting out justice to millions who were affected by riots,Bhopal Gas tragedy & the like.
In case of Bhopal gas incident which left millions dead,disabled etal,,I think all our ministers,politicians,bureaucrats are in overdrive.They are all trying to go to US to supposedly get Anderson's extradition so that he will tell sorry for the mishap ! But then ,this will perhaps be the most expensive sorry so far ! We might even create a world record for the most exorbitant regret ! No because,Anderson or Dow,the new owners will pay anything but because of all the US jaunts by our countrymen !
Since the ruling party has regretted the acts which led to the anti Sikh riots,will it similarly accept an apology for the Gujarat riots from the Gujrat CM ? This has been rightly asked by the safforn party.If the answer is in negative,may we know the reason.This is double standards-one for the ruling party & another for the opposition.No,I am not trying to say that the Lotus was right in the Gujrat riots & the Hand was wrong in the 1984 riots in Delhi.I am just highlighting the dangers of where all this regret in the public domain is leading us to.Our netas are having a ball as they can aid & abet riots etal today & say sorry tomorrow & be done .There is nothing to refrain our so called leaders from repeating such wanton acts ad nauseaum.
Now,if we could say sorry like our netas,we could get so many things done or undone in our private lives.Men especially find it difficult or rather impossible to say sorry .They believe that they are infalliable as they are of a superior gender (? ! ).Most of all,they never say sorry to their life partners.Rarely when they say it,it is just in the air.There is no feeling of regret.It is as if they are obliging their spouses.But in private lives also, an act or ommission cannot be just wiped away by a regret hows ever heartfelt,the apology may be.Because all said & done,one cannot travel back in time & correct that which has been done.Unfortunately,a bigger & more brutual act may make us forget an earlier less painful folly.
So,let us be very careful when we say,do or omit to do something which might lead to consequences which may need more than a lifetime or maybe many lifetimes to regret.After all, as long as we live socially,our acts & ommissions affect one & all.
Yes,even I have felt wronged.I am awaiting regrets - private ones but will I be able to forgive & more importantly forget ? Maybe, but, I am quite unsure.
Sorry ,I believe is a very convenient word .Convenient, as anybody commits a felony,an act or ommisssion to wrong another or others knowing it to be grossly unjust & then regrets by saying " Sorry ." Hence,it is the most abused & misused word of the English language.
Recently,the Canadian Prime Minister publicly apologized for being apathetic to the Kanishka tragedy.Now,the present Canadian Prime Minister was not responsible for the accident but he said he was regretful for the attitude of his administration .So ,in this case,someone who is hardly to be blamed takes the blame & expresses regret.Moreover,since it is done publicly & by Head of the State,it is a very strong apology.But do the victims feel that this is so ? Is it that all felonies can be done & then apologized in front of the world & so will be forgiven ?Also,as the government is expressing regret,all ought to be forgiven but is this workable ?Perhaps,this means that the said case or felony is a closed chapter now & all should move ahead.It also means that the victims need not keep harping about the same wrong doing.But naturally,there will be new wrongs which have been committed & will continue & so we must move on to those .
Similarly,the Pope has said that he regretted that children were sexually abused by the clergy in some European nations.The Pope probably means that such acts will not be repeated but how anyone can guarantee this is beyond me as the Pope has refused to bring the perpetrators to book.There is nothing which will debar anybody to repeat such wanton crimes .How are these perpetrators different from other similar accused ? Only that these are from the Church -they enjoy a position of trust & hence the crimes are more grave.What about the victims who have suffered for years & come out openly now to complain ? Just a " Sorry " will never be able to erase all the painful & horrific memories for the victims who were so vulnerable at their tender age.
Come to think of it-if US were to say sorry to Japan for the Hiroshima & Nagasaki attacks, Israel were to say sorry for the acts it keeps indulging in Palestine et al,& so on & so forth,there would be peace .The Nobel Peace Prize would then go to the word " Sorry " ! But since,we have to keep giving Nobel Peace Prizes to so many people so as to appear politically correct,we have to keep indulging in acts of war.Then we can pretend to be making herculean attempts at brokering peace & be the contenders for the coveted prize,if not the winner !
When our Prime Minister went to Canada,he apologised at a meeting about the anti -Sikh riots .The idea behind this was that the Indian PM,himself being a turbanded Sikh,his public apology will carry a lot of weight.But can the Sikhs forget & forgive one of the worst nightmares they have faced ? They have lost so much that one brutualised victim had gone on record to say that they had lost all & had nothing left to loose ! If the ruling party thinks that justice has been done by the PM's public apology,then we need no courts,no judges,etal.All public crimes wherein a large number of people were involved can be settled out of court by saying sorry.Only individual acts & ommissions need to be tried & punished.So convenient-our courts as of now have enough judges to try these individual cases.So much time is wasted in having commissions of enquiry ,committees & sub committtees on fact finding missions.But once we no longer need them, where will our retired but pliable judges,beurocrats,politicians go ? They cannot fade into oblivion like us,lesser mortals.So for their sake,we have to pretend that we are indeed serious about meting out justice to millions who were affected by riots,Bhopal Gas tragedy & the like.
In case of Bhopal gas incident which left millions dead,disabled etal,,I think all our ministers,politicians,bureaucrats are in overdrive.They are all trying to go to US to supposedly get Anderson's extradition so that he will tell sorry for the mishap ! But then ,this will perhaps be the most expensive sorry so far ! We might even create a world record for the most exorbitant regret ! No because,Anderson or Dow,the new owners will pay anything but because of all the US jaunts by our countrymen !
Since the ruling party has regretted the acts which led to the anti Sikh riots,will it similarly accept an apology for the Gujarat riots from the Gujrat CM ? This has been rightly asked by the safforn party.If the answer is in negative,may we know the reason.This is double standards-one for the ruling party & another for the opposition.No,I am not trying to say that the Lotus was right in the Gujrat riots & the Hand was wrong in the 1984 riots in Delhi.I am just highlighting the dangers of where all this regret in the public domain is leading us to.Our netas are having a ball as they can aid & abet riots etal today & say sorry tomorrow & be done .There is nothing to refrain our so called leaders from repeating such wanton acts ad nauseaum.
Now,if we could say sorry like our netas,we could get so many things done or undone in our private lives.Men especially find it difficult or rather impossible to say sorry .They believe that they are infalliable as they are of a superior gender (? ! ).Most of all,they never say sorry to their life partners.Rarely when they say it,it is just in the air.There is no feeling of regret.It is as if they are obliging their spouses.But in private lives also, an act or ommission cannot be just wiped away by a regret hows ever heartfelt,the apology may be.Because all said & done,one cannot travel back in time & correct that which has been done.Unfortunately,a bigger & more brutual act may make us forget an earlier less painful folly.
So,let us be very careful when we say,do or omit to do something which might lead to consequences which may need more than a lifetime or maybe many lifetimes to regret.After all, as long as we live socially,our acts & ommissions affect one & all.
Yes,even I have felt wronged.I am awaiting regrets - private ones but will I be able to forgive & more importantly forget ? Maybe, but, I am quite unsure.
Subscribe to:
Posts (Atom)
