The Hindu Business Line : Need for better servicing of mediclaim policies

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Coimbatore Feb. 16 Establishment of a network of service centres or a 24-hour help-line would help insurance companies service mediclaim policies better, perceive insurance industry insiders.

"Today, every player in the insurance business, including its bancassurance partner is aggressively marketing mediclaim policies. And because medical expenses are becoming unaffordable, the response to this product is good. The claims and disputes arising thereafter are on the rise. In such a scenario, insurance companies should strengthen its service centre network," a reliable source told Business Line.

TPA Facility

While admitting that bancassurance tie-ups helped insurance companies reach untapped pockets, the source pointed out that the bank-insured relationship ended with the sale of the policy. "The bank shares a percentage of the commission with the insured. He (the insured) therefore enjoys paying a lesser premium. Ultimately, there is no servicing officer for claims. In an eventuality, the insured cannot approach the bank or a TPA (Third Party Administrator) for help, nor can he hold anyone responsible."

Meanwhile, the rising disputes in settlement of mediclaim policies has compelled some of the hospitals in the city withdraw the TPA facility.

Cash Settlement

"While a majority operate through TPAs and some hospitals even get good business through TPAs, some have been bitten badly. A good number of hospitals in Mumbai have reversed from TPA and some of the hospitals in Coimbatore are following suit. Hospitals prefer cash settlement," the source said and explained that the insurance companies mediated through a TPA.

While emphasising the need for greater insurance awareness, the source said "most people ask for a cut in the premium without understanding the implication," and cited that in a particular instance, an insurance company offered to give a cut by excluding the pre and post-hospitalisation cover in the policy. "The hidden implication would be more costly," he added.

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