Third party payers improve or unduly complicate the healthcare delivery system why or why not and how do you think the third party payer system could be improve?

Answer 1

Well, it is the Insurance Cos. who have bestowed the responsibility of looking after medical claim affairs upon the Third Party Administrator (TPA) to shed their headache. The TPAs have their selected Net Work Hospitals wherein the Insured person can opt for cashless facility. For Non net work hospitals, they are to go through reimbursement process. Now, this system has its own merits and demerits. The TPA have their specialized personnel and panel of Doctors who oversee the whole process from patient admission to claim finalization. But there is a tendency among the TPAs to overreact in looking after their own vis-a-vis Insurance Co's interest, to the detriment of the insured party. There is an inherent scepticism among the TPAs that passing claims at random might lead to denial by Insurance Cos afterwards,affecting their payment of bills by them.

The panacea lies in implementation of packages for all major diseases so that there cannot be any arbitrary denial by the TPAs and rushing to Insurance Ombudsman for remedial measures by the patient parties.