In continuation, the supposed 2 companies – 1 of them without any remorse and/or notification to its policy holders have made CO-PAY compulsory on all policies and it is now it is a slab of 70%. THIS IS ARIBITARY AND HOW IRDA ALLOWED THIS IS A MILLION DOLLAR QUESTION; the insured will know about this only if he/she is forced into a situation of hospitalization and one cannot imagine their plight and the role of TPA’S ON THIS ISSUE.
The other company [both companies referred here are private players],and, it needless to add – how the BABUS are silent on the issue; the 2nd company is now facing a W.P. in High Court, under Article 226, read with relevant provisions of Cr.P.C & IPC, apart from other petitions in the lower courts, and, IRDA is one of the Respondents too; their blatant attitude is available on records – there is a reimbursement claim – which takes 4 months for processing [imagine if the patient was in hospital seeking cashless treatment – one shudders to think and this company is a big player in various fields; they deduct ‘X’ amount from the reimbursement sought[nothing submitted in writing, as yet & they add a rider that on settlement they would be cancelling the policy which has its validity for another FOUR months – [THIS IS NOT PERMITTED UNDER LAW AND / OR RULES GOVERNING THE HEALTH INSURANCE].
The issues get murkier and adding woes to senior citizens who depend on insurance as their income has shrunk; none seem to notice these issues and neither the Finance Ministry and the Ministry of Health seem to have time for such serious issues which needs to be revisited; there is a RULE which without ambiguity states that one among the stake holders [THE INSURER], must be a full time member of the Board of Directors and no HEALTH INSURANCE COMPANY HAS ONE AND EVEN WORSE this particular rule is just IGNORED.
The author is gathering more details – especially ones wherein the banks/financial institutions are corporate agents as prescribed by IRDA to sell policies but have no responsibility except the sale made and commission earned – looking at this scenario the role of the TPA though dubious and has several grey areas – they at least pretend to coordinate between the INSURED & THE INSURER – some of the TPA’s are genuine – one cannot deny that too.
This SAGA will continue, the author is making an attempt to bell the cat – whether the noise of the BELL will be heard in the right quarters and action initiated to correct the malaise spreading.