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Latest News |
| 25th
Aug 2010 / Times of India / Pune Edition |
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Non-MBBS docs process med claims
80% Papers Screened By Homoeo, Ayurveda Practitioners
The spat between the medical fraternity and public sector
insurance companies over the cashless health facility
and standardized rate card prepared by the General Insurance
Public Sector Association (Gipsa) has seen many skeletons
tumble out of the proverbial cupboard. But the one that
has got everyone sitting up and taking notice is that
aside from a small panel of MBBS graduates and doctors,
most of the Third Party Administrators (TPAs) who process
consumers claims for insurance companies are ayurveda
and homoeopathy graduates who have no background in allopathy.
When in doubt the internet comes to their rescue, enlightening
them on medical facts.
Calls to several TPAs have confirmed that the first level
of screening of a patients medical papersgiving information
on diagnosis, treatment and hospitalisationis carried
out by doctors who do not have an MBBS degree.A senior
TPA official put the percentage to anything between 85-90
%. Ayurveda and homoeopathy graduates form up to 90% of
doctors scrutinizing papers in most of the TPA offices,
he said.
A medical officer from Medi Assist TPA said that of the
30-odd doctors examining medical papers in his organisation,
around 25 are from non-allopathic backgrounds. We do have
a panel of senior allopathic doctors who look into major
surgeries, said the doctor.A medical officer from Paramount
TPA said none of the graduates are specially trained to
scrutinise surgeries. A bit of modern medicine and surgery
is also taught to us during our course. That comes handy
here, he said, admitting that many of them use the internet
to crack tough medical terms.
Designated as medical officers, recent graduates who have
completed a Bachelor of Ayurvedic Medicine and Surgery
(BAMS) or Bachelor of Homoeopathic Medicine and Surgery
(BHMS) see this as a promising career option. TPAs argue
that no MBBS graduate is willing to work for an annual
pay of Rs 2-3 lakh.
Spokesperson for TPA Association S K Mahapatra said: For
any MBBS doctor, this job will not be the first preference.
Ayurveda and homoeopathy doctors have been clearing claims
for years without a hitch. More than 18 lakh claims are
settled by these doctors annually, including 350 cashless
procedures every day. There is no reason to doubt their
proficiency. Many of the top positions are occupied by
BAMS and BHMS graduates. We have learned over years of
experience, said an assistant general manager of a Delhibased
TPA who has an ayurvedic background. More than 90% of
the claims are simple surgeries. For the rest we have
a special panel of senior MBBS doctors.
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