Page 276 - IC38 GENERAL INSURANCE

Re-pricing is typically characteristic of US healthcare and as such, is not
applicable for non US cases. This is a major difference between cashless
medical case in US and non-US cases.

c) Claims processing Steps:

i. The claims assessor receives the re-priced/original bill, verifies and
ensures that coverage was in place for the dates of service and
treatment rendered. The bill received by the Assistance Company is
audited by the claims department to ensure the charges are in line and
as per the treatment protocol. The discount is re-confirmed and the bill
is processed.

ii. The bill is then sent to Insurer for payment accompanied by re-pricing
notification sheet and explanation of benefits (EOB).

iii. Insurance company receives the bill and authorizes immediate payment
to Assistance Company.

d) Payment process steps:

i. Assistance Company receives authorization from Insurer to release
payment to the hospital via local office.

ii. The finance department releases the payment

e) Hospitalization Procedures

i. The system in overseas countries, especially US and Europe are quite
different from the hospitals in India since majority of population has
universal health coverage either through private insurance or through
government schemes. Most hospitals accept Guarantee of Payments from
all international insurance companies once the insured provides them
with a valid health or overseas travel insurance policy.

In most countries treatment is not delayed for want of confirmation of
insurance coverage or cash deposit.

Hospitals start the treatment immediately. If there is insurance cover the
insurance policy pays or the patient person has to pay. The hospitals tend to
inflate charges since payments are delayed.

If payment is immediate, hospitals tend to offer very high discounts for
immediate payment. Re-pricing agencies generally negotiate with hospitals
for discounts for early settlement of hospital bills.

ii. Information regarding network hospitals and the procedures is available
to the insured on the toll free numbers provided by the assistance
companies.

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