Guys, this experience of mine with TTK is truly remarkable, atleast after reading other reviews in MS. I have a corporate - group insurance policy from my employer with Oriental Health insurance Co. For this
insurer, TTK is third party administrator (TPA) which handles the claim dept. My mother was operated for neurosurgery operation at Fortis, Delhi.Hospital estimated total cost for this surgery to be around 1.75 lakhs before admission which could increase or decrease based on actuals. As every hospital functions, they asked for atleast 50% of money to be paid in advance for the treatment.
Since we had insurance, we chose to go for cashless facility from TTK in networked hosp’. Hosp’ admin
had a separate staff to handle TPA’s which helped in explaining pre-authorisation procedure. Hospital
faxed the important dox including doc’s prescription for surgery. TTK takes 6 hrs to reply for pre-auth.. Meanwhile I checked all the reviews related to TTK on MS and other places, which were all in bad taste.
This made us anxious if our all costs would be approved or not. But after 6 hrs we got a initial approval of
only Rs. 80, 000. I got pissed off with this reply and approached my HR to ask TTK to sanction 100% cost.
HR explained to me, that 100% will be ultimately covered and this is just a INITIAL approval and finally at
the time of discharge TTK will approve 100% except few things which are not covered under policy. This
talk gave me some soothing.
Once the hosp’ admin got the initial approval, they admitted my mother and started their treatment. They also
explained me what TTK will cover under this policy and what not - for which patient will have to pay himself.
( NOT COVERED LIST has very small items in the list which are basic for medical purpose yet not covered like crap bandage/wheel chair/urinal pots/admin charges-hosp’ etc etc). After surgery went fine, mother was shifted to ICU, which is charged higher than normal room charges. This needed doc’s approval in written so as to be paid by TTK. After few days of recovering, doc told us to get her discharged. Now here comes the most unbelievable part. I had a perspective that medical insurers/TPA’s will always put one or the another clause to logistically harass the patients/relatives so as to they give up claiming bills. I thought insurers have hired TPA’s (like TTK in my case) as a front desk to discourage people claiming bills and only keep making money from high premiums. So I was mentally prepared from the beginning to collect each and every prescription from Doc’ and thoroughly go by each and every line of TTK policy T&C to follow every process.
Before I could even start taking actions for final settlement between me, hosp’ and TTK, I received info from my
father that doc’ had already discharged my mother this morning and TTK has also faxed us final approval for all costs covered under policy. This took time for me to realise the truth. Later I learned as soon as the doc discharged my mom, hosp admin came into action and gathered all original prescriptions/bills/reports and faxed it to TTK and within 2 hrs time, TTK also replied back by faxing the approval for everything (Rs. 1, 75, 000). This was joyous time for my family as major cost has been already paid without our intervention or fight withhosp’/TTK. Everyone was happy at the time of leaving hospital. Though we had to pay a minimal extra cost of Rs 30, 000 whose details were easily understandable and were also told to me before admitting my mom.
After this experience, I like to draw my understanding in the form of eco-system existing in this business.
1) TPA’s(Third Party Administrators) - they can be described as frontdesk person or claim dept authority on behalf of your medical insurer(in my case - Oriental ins.) They can create problems logistically by declining on
grounds of insufficient data/papers or alerting them at right time. There behaviour can also depend on their
partner insurer like in my case oriental ins. which is a govt insurer having very good claim ratio history.
As I read in other reviews icici’s medical ins has very bad claim ratio record, that’s why TTK might also
create tons of problems for icici’s med ins policy holder. Afterall its insurance Co which will pay money to TTK and in turn that money is paid to hosp. TTK only facilitates the process. Well this understanding is from my
experience, which could be far away from the truth.
2) Medical Insurer - It was Oriental Medical insurance Co (govt Co) which has tied with my employer to cover
me and my dependents under group staff insurance. Each employee along with his/her spouse, two parents and children are covered under this. Oriental has a good record of claim ratio in the market and that too since its a corporate policy for me, they will have to serve us quickly and effectively.
3) Policy Holder - in this case was me, my parents and spouse as a corporate policy holders. Had it been a individual policy purchased directly, I guess my story could have turned on sour side. So I infer- being a corporate policy holder, it was TTK’s/Oriental’s stake at hand to entertain my claim request as not doing this
would have gathered bad opinion about them and consequently their annual contract of huge premium amount would be impacted negatively.
Hence, being a corporate policy holder was definitely an advantage in my experience.