Docs feel short-changed by TPAs' 'discount norms'

AHMEDABAD: The decision of the Insurance Regulatory and Development Authority (IRDA) to appoint Third Party Administrators (TPA) to monitor and settle claims against medical insurance and provide cashless mediclaim facility has city doctors up in arms. In Ahmedabad, many doctors have been approached by TPAs of the four main General Insurance companies, to be a part of their panel of doctors from who patients can receive cashless mediclaim services.However, the Ahmedabad Medical Association president Dr Dileep Vaidya has written to the insurance companies complaining that many doctors were asked to provide discounts to be a part of their panels. This is unfair. Many doctors say the TPAs have asked for varying discounts between 30 to 10 per cent on bill amounts to induct them on their panel and in turn this doctor would be assured a large number of patients who have the mediclaim policy, says Vaidya. The doctors who refused to give discounts are not on the panel. But in case where the doctor or the hospital is famous the TPAs have included them, he said. Manager of a TPA, Heritage Health services, Vishal Sharma says the discount is necessary to reduce the claim ratio to survive in the market. We have so far tied up with 180 hospitals, but we do not force doctors or hospitals to give us discounts. If a doctor or hospital is famous, we have to take them on our panel as the insurance buyer may want to avail of his services, he said. According to another TPA, the Paramount Health Care, they enter into an MoU with hospitals and doctors so that they can provide cashless services. We do not charge any discount for the same, but they have to follow certain guidelines as decided by the General Insurers Public Sector Association (GIPSA) to be on our network, says its vice president Dr N N Shah. The GIPSA comprises four main insurance agencies — National Insurance, New India Assurance, Oriental Insurance and the United India Insurance, which has laid down norms for hospitals and nursing homes to be included in their network of doctors offering cashless services. Acting president of the All-India Indian Medical Association Dr Jitendra Patel criticises this arm-twisting saying, I have received many complaints from colleagues about TPAs seeking discounts to allow them on their panel of doctors for cashless service privilege, he said. AMA vice president Dr Vijay Bhatiya too admits having received complaints from many of their members about TPAs charging commissions and discounts to allow doctors to be registered on their panels. Their advertisement mentions a charge Rs 2,000 that doctors have to pay to get themselves registered, he says. A professor of finance from IIMA, Ramesh Bhat in his paper 'Health insurance and third party administrators: Issues and challenges' notes that although the IRDA has defined the role of TPAs as managers of claims and reimbursements, their role in controlling costs of health care and ensuring appropriate quality of care remains less defined. Rather than asking for discounts they should stress on the quality of care, he says. Karnavati Hospital's Dr D R Shah says he was approached by a TPA to be a part of their panel. But I turned down their demand for a discount. Those patients who seek treatment here would not be able to avail of the cashless services, but they can reimburse bills later, he says. General surgeon Dr Ramesh Parekh who gave a 10 per cent discount to a TPA ended up disappointed because he gave one of his patients a 'cashless service' and submitted the bills two months back and is still awaiting payment by the TPA. Now I would be reluctant to offer cashless service, he says. Another TPA, Med Save Health Care Limited's branch manager Parinay Sinha pleads that TPAs should be given some time to establish their network. We are offering the doctors a client base of all insured clients of the insurance companies who we serve. He says they ask for a discount for bulk buyers, but it is not compulsory.