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M. Ramesh

Chennai , Oct. 17

NOTWITHSTANDING the current state of the TPAs, there is unanimity in the view that the future would be better. Fundamentally, because the rising health costs would force people to cover themselves with insurance.

As hospitals and TPAs connect up, and the teething problems get overcome, customers would accept health insurance better.

Today, the customer experience with TPAs is not bad. Complaints are basic in nature, such as delay in issuance of identity cards, (which according to insurance companies, happens because of faulty documentation).

Says Ms Ujjaini Dasgupta, CEO of Medicare Health Services, "Whenever there is inadequacy in terms of documentation we request the customers for such documents, but unfortunately very few policy holders respond. "

There have been other little glitches. Some illnesses are not covered in the first year. Then there are issues relating to hospitals' willingness to entertain TPAs. "Hospital authorities are not encouraging the system," Mr S. Sundaresan, Assistant General Manager of United India, says.

However, the initial resistance is being broken down and hospitals are slowly getting allied to TPAs.

For example, family health plan works with 1,250 hospitals, medicare with over 500 and universal with over 800.

Second, for hospitals accustomed to getting their charges paid upfront, there is some distrust of TPAs.

According to industry sources, there have been a few instances of TPAs not settling their hospital dues, resulting in the hospitals blacklisting them. But TPAs in turn say that the insurance companies did not make `float funds' available to them, out of which they should have settled the claims.

But over time, these glitches will get ironed out, say those in the industry. The following things are expected to happen:

More hospitals will come into the network, as they will get more patients;

There will be a shake-out among the TPAs — the better ones will survive and do better;

The commission is to come up for review and there could be an upward revision;

With the private sector also getting into the act, there will be an increase in the level of awareness of health productsand

Fraudulent claims will be fewer and both insurers and TPAs will stand to gain.

That is why there is a perception that the future for TPAs is secure. But for this `future' to happen fast, the industry suggests that there be a fresh look at the TPAs.

Mr B. Chandrasekar, Vice-President, Corporate Relations, of Family Health Plan agrees. He wants the insurance companies to give more business to the "serious and experienced" TPAs, who are willing to invest further.

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