Have proper paperwork to cover dependant under employer policy

This article was first published in Mint Money.

Shyamal Banerjee/Mint

Shyamal Banerjee/Mint

Health insurance adoption, utilisation, and administration each pose a unique set of challenges for various stakeholders—insurance companies, third-party administrators (TPAs), regulators and government bodies, and hospitals—of the insurance ecosystem. Seamless individual processes and functions from each of the stakeholders that come together cohesively can provide customers with a health insurance cover that they can use without experiencing a financial crisis for the treatment.

Over the last decade or so, corporate group health insurance covers, offered by employers to their employees, has come to form a significant chunk of health insurance penetration in India. Under such a policy, not only is the employee covered, (depending on the policy terms) their dependents such as spouse, children and parents are also covered. The sign up process involves the employee submitting forms that contain the employee’s and her dependents’ details to the human resources (HR) department, which in turn consolidate and send the information to the insurance company or the TPA. Following this, the health insurance policy ID cards are handed over to the employee.

In most cases, corporate policies are cashless health insurance policies, wherein the patient is not required to pay upfront cash and the bill is settled between the hospital and the payer or the TPA (with a small percentage of copayment or exceptions not covered under the policy being borne by the patient). At the hospital, the claim is processed by the hospital TPA desk, which coordinates with the TPA who adjudicates the claims on behalf of the insurer to settle the insurance claim against the bill. Thus, pre-authorisation of the sum payable and patient’s eligibility are processes that rely on the information shared by the patient at the time of sign up.

In the case of a dependent, to utilise the policy, they have to be enrolled as dependents in the TPA systems. In many cases, dependents are not enrolled in the TPA systems even though the relevant forms may have been filled in the beginning. Owing to various reasons including, the use of unstructured communication channels between HR and the insurer or the TPA, this information does not flow to the TPAs. Thus, even though the employee may have filled the forms to include dependents under the employee provided cover, there can be significant delays in receiving the approvals from the TPA leading to avoidable heartburn and stress for the policyholder at the time of availing the treatment.

In such scenarios, the primary policyholder and her dependents using the policy for treatment are likely to face problems such as the ones mentioned below:

Difficulty in enrolment: To get the dependent enrolled with the TPA, the primary policyholder will have to get in touch with all parties involved—the HR team with the employer, the insurance company, and the TPA. Various rounds of back and forth involving calls and e-mails, documentation with each and response time that can go up to several hours derails the treatment and adds to the patient’s woes.

Mounting costs: As a result of the added time (and days) spent in getting the insurance procedure going, along with delays at all stages, the time spent at the hospital can potentially escalate costs or there may be a need to make a deposit to the hospital upfront due to lack of approval from the TPA. This, in turn, can add unnecessary costs to your final bill and become a financial burden that could have otherwise been avoided.

What should the primary policyholder do?

To ensure that the dependents are enrolled in the TPA systems, it is best that the employee follows up with the relevant department and the company’s HR team to get a confirmation regarding this as soon as sign-up is completed.

This will ensure that in the unfortunate situation of a medical need for any of the dependents, precious time is not lost. At the time of crisis, the primary member and her family does not have to go through a bad experience while availing cashless treatment. Taking a few precautions and being prepared for such situations can help policyholders greatly reduce the stress related to availing insurance.

While the health insurance ecosystem gears up to adopt electronic platforms, it is wise for the policyholder to take necessary precautions to ensure that this does not add to the worries and stress at the time of any hospitalisation.

Munish Daga, chief executive officer, Remedinet Technologies Pvt. Ltd.

Read the rest of this entry »


Speciality clinics looking to healthtech startups for IT upgrades

This article was first published in the Times of India.

CHENNAI: Hospital chains like the Apollo Group, Manipal, Columbia Asia and Fortiswere among the first in India to invest heavily in IT. Joining their ilk are speciality clinics like Vasan Eyecare, Davita, Narayana Health, HCG and Agwaral Eye Clinic, which now taking to the IT highway and upgrading to ICD10 code compliance, payment-facilitating web portals, creating mobile apps, maintaining electronic health records and booking doctors’ appointments.

Startups like Remedinet, S10 Healthcare, Medi Assist are coming to the rescue of such speciality clinics for cancer, cardiac, dental and eye care. Medi Assist, which recently invested $1 million in Goa-based mobile fitness venture MobieFit, has come up with MediBuddy, a mobile app for hospitals and specialty clinics. The mobile app allows policyholders to raise and track claims, plan an e-cashless hospitalization, search networked/empanelled hospitals, book wellness services, buy drugs and maintain electronic health records. “We also have e-cashless, which helps users book cashless admission at a network hospital using their smartphones. You can choose the room type, get an idea as to projected bill, cost of treatment, and cut out waiting time for hospital admission,” said Prashant Jhaveri, head, products and strategy, Medi Assist Healthcare Services, which also has a MediBuddy web portal for access to health benefits.

Read the rest of this entry »


Fixing Health Insurance’s Health

This article was first published in the April-June issue of the IRDA Journal.

India, a massive country with a population of 1.2 billion (source: wikipedia.com) stands on the historically rich soil where Ayurveda was born and surgery techniques once flourished. It is ironic how its people are perishing in the absence of the same healthcare services in the present era. Innovations in science and technology have certainly improved the very field of healthcare but at the same time, have done little to nothing for the masses at large. A major part of the population does not have access to basic healthcare services while, the benefits of the innovations are enjoyed by the ones with deep pockets only.  For around 70% (source: world Bank)  of the population living in the rural areas, the healthcare facilities are in a dismal condition. The inadequate number of Public Healthcare Centres adds further to the woes. .

Read the rest of this entry »


This Indian Tech Disruptor Is Changing India’s Health Insurance Claims System

This articles was first published on Forbes Asia Online.

If you suffer the misfortune of being an inpatient in the Indian medical system, you may find your time spent trying to file health insurance claims ends up being longer than your time as a patient, because it’s all being filed by hand. One company set out to be the first to solve this, finding an unusual new problem ahead.

After hearing about an inpatient insurance claims experience, Remedinet CEO Munish Daga says he realized that the process was unnecessarily painful, taking between four and six hours to complete in many cases.

Read the rest of this entry »


Our platform cuts claim adjudication time by 50%

This article was first published in Mint on 24th July.

 

Photo: Hemant Mishra/Mint

For health insurance to be truly cashless, it’s important that hospitals and insurers talk to each other in real time. Remedinet Technologies Pvt. Ltd is a cloud-based platform that aims to simplify the back-end of cashless claims by connecting hospitals to the insurers. Munish Daga, chief executive officer of the company, spoke to Mint and explained how the platform reduces the turn-around time on claims settlement.

Read the rest of this entry »


Remedinet for Cashless Outpatient Health Insurance

Cashless Outpatient Health Insurance Cover can be made possible using Remedinet’s technology solutions

All parties involved can transact in real-time and share information, including reports in an electronic format

By connecting the entire ecosystem using a mobile application, beneficiaries can utilize outpatient health insurance at the click of a button.

Out Patient_Poster A2 size-page-001.jpg


Remedinet’s pill for cumbersome insurance claims

This story was first published in the April issue of Forbes India Magazine.

If patients find it difficult to get their claims cleared and approved by insurance companies, hospitals too face their own share of bottlenecks while dealing with cashless insurance claims.

Read the rest of this entry »