January 2012
TPA Symposium
Dr. KY Narasimha Murthy's Report of the TPA symposium held at St. John's Auditorium on 13-01-2012
SYMPOSIUM ON TPA ISSUES
Challenges in hospital receivables/payments – TPA’s / Insurance
Symposium was organized by BOS TPA committee at mini auditorium in St’Johns Medical College Hospital on 13th Jan 2012 Friday at 8 pm. It was a dinner meet and the duration was 90 min.
Symposium was well attended by Bangalore Ophthalmologists. Session was chaired by Dr.M.S.Ravindra, Secretary BOS. Program was hosted by TPA sub-committee BOS, headed by Dr. Y.L.Rajashekar. It was a dynamic and vibrant session due to the inspirational talk from eminent speakers like Dr. Quresh .B .Maskati a renowned Ophthalmologist from Muimbai. Dr.Maskati narrated his Mumbai experience with advice as to how to handle TPA’s with terms & conditions. He also advised not to accept cashless facility as the pricing policy of TPA’s is unacceptable. He also emphasized to educate the patients about the treatment plan & the pricing policy which cannot be brought within the frame work of TPA recommended tariffs. He insisted that we should encourage the patients to pay the cash upfront & give all the necessary documents to the patient which will help him for getting the reimbursement from the insurance companies. He advised all the Ophthalmologists to come together on this issue & to take up the support from other medical associations. In case this is not taken up at this moment, the pricing policy (Tariff fixed to surgeries) from TPA’s may further shrink & it may be difficult to handle activities in any Organizations. He also offered his help whenever required by BOS. He warned us not to sign any MOU’s without discussing it in the Society.
Next speaker Mr.H.S.N.Rao, CEO of ARC Insurance Brooking Pvt Ltd, formerly Regional Head of National Insurance, gave a reality picture of Health Insurance Claims in India. The statistics showed highest claim rate with respect to eye procedures in Bangalore. He gave a reality picture of TPA Insurance scenario which gave a better understanding to all the audience regarding TPA transactions. He also offered his help as an adviser to BOS & its members to handle TPA issues.
Finally Dr.N.S.Murali, Gastroenterologist from USA, warned the entire medical fraternity to be very causious while signing with TPA’s. He highlighted the fact that Insurance people applying their knowledge gained from USA experience applying it here in India with full force. In due course of time the surgical rates could slash down as they are interested in improving their profitability. He advised us to maintain state of the art infrastructure & facility, standard health care protocols, expertise & skill & accreditations so that TPA’s should not point out any deficiencies to reduce the Tariff’s.
On the whole everybody concluded, saying when a doctor is treating a patient the contract is between patient & doctor & TPA has no role to decide pricing of the services rendered by the doctor. Educate the patient that TPA/Insurance agents are not their friends. In the beginning of the session Dr.K.Y.Narasimha Murthy introduced the speakers to the audience & explained the current scenario faced by Bangalore Ophthalmologists with respect to TPA pricing policies. Dr. Y.L.Rajashekar did vote of thanks & specially conveyed thanks to Dr.Manju, Professor of Opthalmology, St, Johns medical college for organizing the hall for the symposium.
SYMPOSIUM ON TPA ISSUES
Challenges in hospital receivables/payments – TPA’s / Insurance
Symposium was organized by BOS TPA committee at mini auditorium in St’Johns Medical College Hospital on 13th Jan 2012 Friday at 8 pm. It was a dinner meet and the duration was 90 min.
Symposium was well attended by Bangalore Ophthalmologists. Session was chaired by Dr.M.S.Ravindra, Secretary BOS. Program was hosted by TPA sub-committee BOS, headed by Dr. Y.L.Rajashekar. It was a dynamic and vibrant session due to the inspirational talk from eminent speakers like Dr. Quresh .B .Maskati a renowned Ophthalmologist from Muimbai. Dr.Maskati narrated his Mumbai experience with advice as to how to handle TPA’s with terms & conditions. He also advised not to accept cashless facility as the pricing policy of TPA’s is unacceptable. He also emphasized to educate the patients about the treatment plan & the pricing policy which cannot be brought within the frame work of TPA recommended tariffs. He insisted that we should encourage the patients to pay the cash upfront & give all the necessary documents to the patient which will help him for getting the reimbursement from the insurance companies. He advised all the Ophthalmologists to come together on this issue & to take up the support from other medical associations. In case this is not taken up at this moment, the pricing policy (Tariff fixed to surgeries) from TPA’s may further shrink & it may be difficult to handle activities in any Organizations. He also offered his help whenever required by BOS. He warned us not to sign any MOU’s without discussing it in the Society.
Next speaker Mr.H.S.N.Rao, CEO of ARC Insurance Brooking Pvt Ltd, formerly Regional Head of National Insurance, gave a reality picture of Health Insurance Claims in India. The statistics showed highest claim rate with respect to eye procedures in Bangalore. He gave a reality picture of TPA Insurance scenario which gave a better understanding to all the audience regarding TPA transactions. He also offered his help as an adviser to BOS & its members to handle TPA issues.
Finally Dr.N.S.Murali, Gastroenterologist from USA, warned the entire medical fraternity to be very causious while signing with TPA’s. He highlighted the fact that Insurance people applying their knowledge gained from USA experience applying it here in India with full force. In due course of time the surgical rates could slash down as they are interested in improving their profitability. He advised us to maintain state of the art infrastructure & facility, standard health care protocols, expertise & skill & accreditations so that TPA’s should not point out any deficiencies to reduce the Tariff’s.
On the whole everybody concluded, saying when a doctor is treating a patient the contract is between patient & doctor & TPA has no role to decide pricing of the services rendered by the doctor. Educate the patient that TPA/Insurance agents are not their friends. In the beginning of the session Dr.K.Y.Narasimha Murthy introduced the speakers to the audience & explained the current scenario faced by Bangalore Ophthalmologists with respect to TPA pricing policies. Dr. Y.L.Rajashekar did vote of thanks & specially conveyed thanks to Dr.Manju, Professor of Opthalmology, St, Johns medical college for organizing the hall for the symposium.
