February 5, 2009 1:27:44 am
When Rastapeth resident Baljeet Singh met with a bike accident on January 30,he was not unduly worried about his hospital bill as he had a cashless mediclaim policy from ICICI Lombard. In other words,the company would settle the bills directly with the hospital.
But it didnt quite work out that way when he tried to settle the Rs 13,000-bill at a leading city hospital a day later. Though Singh was discharged in the morning,he waited till evening for the insurance company to authorise his payment through the third party administrator (TPA). When that was not forthcoming,by 6 pm he was forced to make alternative arrangements. Otherwise,he would have been forced to continue staying in the hospital,for which the insurance company is not liable.
When they sell the policy,they call it cashless. I did not see it happening with me. Nor was the service quick. It was only an additional source of tension for me, said Singh,himself possessing IRDA licence though he does not practise. I came to this particular hospital only because I was promised that my insurance company would pick up the tab. Otherwise I would have stayed at home and gone to a clinic to get the stitches done, he said. His insurance finally came thorough on February 2 evening,after repeated calls.
K C Mishra,director of National Insurance Academy,calls it a systemic lapse. The hospital authorities and the TPA have ways to check from the cashless card if the patients insurance cover is adequate at the time of admission. Once the hospital accepts the mediclaim card and agrees to cashless service,the insurance company has to pay up,failing which the insured is eligible to file a suit against the company with the ombudsman, he said.
For claims above Rs 20 lakh,the insurer can approach the consumer courts.
According to Mishra,if 54 Indian companies could offer online insurance services for American patients with efficiency,they could surely offer the same level of service to Indian customers. The delay happens because we tolerate it, he said.
Cashless service is a misnomer, said an officer with a leading city hospital,who deals with mediclaim policies on a daily basis. Every week there are at least a few angry patients like Singh who have to put up with long delays, he said. An ICICI spokesperson admitted that there were instances of friction between the customer and the company.
Once we get the pre-authorisation form from the hospital,it takes about eight hours to send the authorisation. But if there are additional documents to be procured from the patient,then it might lead to some delay, he said.
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