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Industry : Insurance
Functional Area : Business Policy
Activity: Question posted: 05 21 2009 12:47:57 +0000, 6 answers, 255 views, last activity 07 06 2010 20:18:08 +0000
 
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Recently I came across a news saying that some corporate hospitals are misusing the health insurance. This is a issue which need to be addressed. So can you all please suggest what can be preventive measures for this ? If this is not taken care of, it will prove a great loss for the industry.

 
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These points are very Much correct On the appointed day the exec from one of the private company came all the way from Andheri to my place at Kalyan.  He was shocked when I told him upfront about the 2 things which I had informed their call center.
He immediately called up his senior and reported the matter. He also regretfully told me that their company did not have any non-ULIP scheme.   Needless to mention here the outcome of our meeting.



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by   sujit Kumar, Marketing Manager, Wipro Peripherals  | 06 12 2009 16:01:39 +0000
  Answered by     Sharath Kotian, Development Officer, Life Insurance Corporation Of India  | 05 26 2009 16:01:09 +0000
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First of all, all the private insurance companies should be stopped from using the services of the call centers.  These call center either does not train their people or they give them wrong training regarding the products they are representing.  These call center employees comprise of mostly young boys and girls who are more interested in making a quick buck by making more calls and "fixing" up appointments with "customers" who are either not aware or the insurance company executive is unaware of the customer's background.
I will cite a classic example of my own self.
One fine day I received a call from one such center.  I clearly told him two things 1...that I am not interested in any of the ULIP plans and 2... that I am an LIC employee.  Please send your executive if he has any non-ULIP plan.  The call center guy agreed and assured me in this regard.
On the appointed day the exec from one of the private company came all the way from Andheri to my place at Kalyan.  He was shocked when I told him upfront about the 2 things which I had informed their call center.
He immediately called up his senior and reported the matter. He also regretfully told me that their company did not have any non-ULIP scheme.   Needless to mention here the outcome of our meeting.
The second most important thing which I want to highlight here is that I have been visited by at least 5 "executives" of 5 different Life Insurance companies and out of this 2 did not have a proper identification and NONE of them possessed an IRDA license to sell insurance policies, they had not even passed the IRDA pre-recruitment exams to become an Insurance seller.  
How can a person be recruited to sell Insurance policies by any Insurance company, not have a proper license?
Hello "IRDA" are you listening? or are you pretending to be blind and deaf as well?
If such is the case, then please understand the plight of our country's lesser educated people who still do not understand much about the difference between Insurance and Investment.
The private companies are here to milk the poor people's hard earned money by cheating them any which way they please.  Every day people receive calls from these cheat call centers.
Beware, the executive visiting your office of residence may not possess a valid IRDA license to sell insurance.  Private companies mostly do not have a non-ULIP life insurance plan.  ULIP plans can be very risky, specially if you do not have proper knowledge of stock markets and NAV's.
IRDA has been coolly turning a blind eye towards these irregularities.  Its a shame.  Private insurance companies are all running into huge losses by the day, still they somehow fudge the figures.  They circulate highly inflated figures in their presentations which is brazenly distributed by the unsuspecting executives to their potential clients.
God save this country's poor from falling into this dirty trap of private insurance companies.

  Answered by     Aditya Sharma, Insurance Advisor/Analyst, LIC OF INDIA, ICICI LOMBARD  | 05 22 2009 15:03:38 +0000
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All the insurance companies can come together and form a information think tank type of thing which will pass on the information of misuse of insurance of one company to all the member companies.The defaulter corporate house can than be easily kicked out . This if not stop atleast reduce the misuse. 2. They should identify the type of misuse and than take corrective measures to plug the hole. 3. There should be more strict selection of the corporate house. These are some of the ways by which companies can stop and reduce misuse of health insurance.

  Answered by     Sanjay Thakur, PhD Student in Finance(Portfolio Risk Management), IIT Bombay  | 05 21 2009 20:20:09 +0000
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Health insurance has emerged as the preferred solution to lower or eliminate financial burden emanating from health risk. Various studies have emphasized on parameters like premium amount, income, education, occupation and age etc. plays important role in determination of demand for health insurance. Surprisingly most of empirical studies haven’t considered “health” as a determinant of demand for health insurance which may lead to adverse selection problem for an insurer and denial of incentive to a healthy customer. In fact, the problem of “adverse selection” and “moral hazard” are more prevalent in health insurance than any other type of insurance.For this, all three- the insurance company, the insured customer and hospitals are responsible.Reasons are as follows:

(i) Insurer level: As already stated, there is  no incentive for "healthy" person of same age group when s/he takes a health insurance policy and neither there is any incentive for him/her to maintain the healthyness.

(ii) Customer level: There is a general tendency to palliate one's health status at the point of application through which consumer may influence the time and scope of treatment (mishra 2008).

(iii)Hospital level: The asymmetry of information that prevails in the market for medical care – with doctors perceived to be having better information about the status of a sick person than others, creates an incentive for doctors to provide more services to patients than may be medically necessary (mishra 2008). 

One consequence is that in a regime of pure indemnity insurance, providers have an incentive to provide more care than may be medically appropriate. For the same reason, the patient or, insurers for that matter, may be less willing to question the qualifications of the doctor as to his or her expertise (Arrow 1963).Also, once insured, an individual faces a reduced incentive to take precautions against poor health.

Solution:

Potential solution may be: Insurer alone shouldnt pay full amount of medical care. Hospitals and Customer should also share certain percentage of the payment , say 20% and 10 % respectively. This will make all three participants as a responsible partners in medical care.At the same time, insurer must provide incentives to them who keep themself healthy than others by re-imbersing their fitness-club/health club membership charges etc., which will encourage others customers, apart from individuals being self-motivated,  to keep fit and healthy.

  Answered by     Vijay Krishna Singh, Unit Manager, Max New York Life Insurance Company Limited.  | 05 21 2009 19:25:46 +0000
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this is very subjective and depends on the quality of services for which the patient has opted and gets admitted in that hospital. u never know how much they charge for what and why. What can b done is that hospitals are given star ratings and the charges are fixed for a particular treatment or room or check-ups or disposables and so on, in the hospitals of the same star ratings, and this can b done when an insurance company empanels that hospital. all life insurers shd get together along with the hospitals to set up an advisory committee to develop this idea and get the ratings done. 

  Answered by     vijayasaravanan , Partner, MS Contractors and Amway Business Owner  | 05 21 2009 13:36:04 +0000
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Actualy this cashless facility is a great opportunity for hospitals. They can debit anything as per their wish. They will get a big chance to misled the patient by giving unnecessary costly treatment for relatively small disease.The insured should be masked from hospitals. Some arrangements should be made that the customer could access cash immediately like cashless facility without the knowledge of hospitals. Like ATMs, all companies can appoint common node for approval.This will mutualy benefit the company and the customer.   

 
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