Revolutionising health insurance with technology

Munish Daga, CEO, Remedinet Technologies, expounds on the scope and possibilities of digital platforms for healthcare insurance in India. This article was first published in the January edition of Express Healthcare.

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The Gap

Despite the technological evolution of the healthcare sector over the past two decades, health insurance in India continues to grapple with the same difficulties such as lack of adoption and complex utilisation. As a result, the adoption numbers struggle to make it past a disappointing percentage figure in a country with the second largest population in the world. On the flip side, the situation in which the health insurance industry currently finds itself, also presents tremendous opportunities to evolve, possibility to scale, and scope to become profitable. The emergency of the situation, in several cases has not only served as a business opportunity, but also led to the adoption of digital frameworks as foundational pillars that ensure last mile delivery of health insurance for the policyholder.

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Pre-intimation can make the hospitalisation experience better

This article was first published in the December 21st issue of HT Mint.

Pradeep Gaur/Mint

Making the adoption and utilisation of health insurance customer-friendly, simple and jargon-free for the policyholder is a continuous process that each industry stakeholder is tackling in its own way.

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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.

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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.

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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.

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Cashless health plan better than reimbursement

This story was first published in the Financial Chronicle on March 15.

Being aware and staying informed about health insurance is as important as having a health insurance policy. The decision you make should be an informed one with all the options on the table. Incidences of individuals being miss-sold and claims getting rejected are plenty.

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Healthcare Glides on Tech Wings

This story was first published in Ehealth’s March 2016 issue

Technological innovations are taking place with a significant growth, changing the shape of various industries as these evolve. Technology plays a pivotal role in all processes, starting from registration of patients to data monitoring, from lab tests to selfcare tools in the healthcare domain Romiya Das of Elets News Network (ENN) finds out how the use of information technology is transforming the way healthcare is being delivered to the patients

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