♣ Non-MBBS docs process claims

80% Of Those Screening Medical Papers Have Ayurveda Or Homoeopathy Degrees
Sumitra Deb Roy | TNN

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 patient’s medical papers—giving information on diagnosis, treatment and hospitalisation—is 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 nonallopathic 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 Delhi-based 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.’’

Source

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