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smoking can give you a heart attack

Smoking, stress and an unhealthy lifestyle can lead to heart attacks!! Here are people for whom a heart attack turned around their lives. They stopped smoking, started regular exercise and ate well balanced diets. Success stories of how they gave up smoking and took a healthy active lifestyle…

Hope it doesn’t take you a heart attack to give up smoking!

Click here for the stories…

Click here to know why smoking is good for you…

 

Kids addicted to the internet

In today’s internet age, almost all of us have a broadband connection in our homes. From internet connection in our PC’s to net connection in our laptops, notebooks and cell phones too, net connection is available at our finger tips. Under such conditions most parents, typically working parents, in urban cities, are either unaware or not in control of the amount of time their children spend on the net.

There is a lot to do on the net. From social networking sites, emails, gaming to videos, songs, etc. it doesn’t take long for kids to get lost in the vast amount of entertainment.

More than half of the kids between ages 8-18 are spending an average of about 5+ hours every day on the net! It is not a phase, he isn’t simply becoming a loner, he is becoming an internet addict!

Becoming hooked on to the net for the right reasons like getting information for a project or reading up about something is to a certain extent acceptable but most children are busy socializing or playing games which can turn out to be pretty harmful. So it is of utmost priority that you limit and supervise the number of hours your child is on the net!

For more information:

Click here – Press release on Internet Addiction Disorder: A Rising Trend In Metros

Click here – An article in the Hindustan Times

 

The director, of Tata Memorial Centre (Cancer Research Centre), Parel, specialized in prevention and management of breast cancer, in an interview with HT, talks about preventive measures and what increases your risk for breast cancer.

Prevention

  • Keeping weight in check - A woman increases her risk of breast cancer by 12% for every 4 Kgs that she is overweight.

    breast feeding

  • Having a child within the right age - For every year after the age of 25 that a woman delays pregnancy she increases her chances of breast cancer by 18%!
  • Breast feeding - Breast feeding actually keeps you safe from breast cancer, in fact for every additional month that the woman breast feeds she reduces her chances of breast cancer by 12-13%.
  • Regular checkups - Every woman must also have regular self – examination, or doctor physical examinations or even regular mammography tests conducted so that she can detect the presence of any abnormality early.

He also suggests physical examinations are better as they are inexpensive and seem to have a higher detection percentage as compared to expansive mammography tests.

The article

 

artificial sweetners do not help you lose weight

Against the popular belief that using an artificial sweetener can actually help you lose weight, Rujuta Diwekar, famous author of ‘Don’t lose your mind lose your weight’, says that it actually helps you put on weight!

She is of the opinion; your total calorie consumption goes up the moment you choose a sugar substitute over sugar. Using these substitutes make you crave for more food, in turn making you consume more. Not to mention the fact that those who drink diet colas assume that they can now binge on pizzas or burgers again increasing your calorie intake.

The extra 20 calories you might gain with a spoon of sugar is nothing compared to the calories you will gain due to binging on more food. So opt for the sugar instead, it will probably keep you thinner!

Rujuta Diwekar’s article

Artificial sweeteners suger-free not risk-free

Honey contains antibiotics

CSE or Center For Science and Environment has again done it. Their study conducted on major brands of Honey in India (Dabur, Baidyanath, Himalaya, Patanjali Products etc) showed that 11 out of 12 contain disturbingly high levels of antibiotics. Not only this, the imported brands (NectaFlor from Switzerland and Capilano Pure from Australia) also contain high levels of anti bacterial compounds which would be unacceptable in their country.

What really is startling is that we don’t have standards for checking the levels of antibiotics in the honey sold in India but have a strict code for checking it for domestic honey which is to be exported. Even foreign brands are taking advantage of this fact and selling honey with antibiotics which would have been rejected abroad.

Why does Honey have antibiotics?

From smaller farmers, honey producers are now large cartels who push for more production and higher profits. Honey producers use antibiotics to prevent diseases among honey bees. This antibiotics are then passed on their honey.  

What does ‘antibiotics’ in Honey affect us?

Exposure to antibiotics over a period of time creates many health problems. One of the antibiotics found in the studied brands honey is known to cause blood disorders and liver ailments. Also long term exposure creates antibiotics resistant bugs which creates large scale problems.

Read the findings here

Macdonanlds fries are harmful

We have all heard that McDonald’s use preservatives in their burgers and fries. But here are very interesting studies and research that can prove how a burger has survived for almost a year! And more importantly what it is in that burger that is the reason for the burgers’ prolonged survival.

There have been cases of fries and burgers that have lasted more than 5-6 months without spoiling. It is a real mystery how McDonald’s manages to do so, and raises the very obvious question of - what are we eating then? Is it safe? Can we continue?

McDonald’s in moderation is not such a bad idea, say some nutritionists while others say that you must abstain from it.

Read and judge for yourself if McDonald’s is really worth it!

 

Click here to know exactly why a burger doesn’t rot…

Click here to read an article written by us that tells you all you didn’t know about McDonald’s…

 

morning healthy juices

For some reason we simply do not have the time to have the recommended 2-4 servings of fruits a day. When we are all in a rush to get to work, trying to manage our time, who has the time to do a daily check on the food we eat?

But what if we told you there was a way to make sure you got the right nutrition at one time of the day, just after the nice ‘rise and shine’?

Morning juices made with the right fruits and vegetables, in the right proportion, includes all the nutrition that we need to keep as going throughout the day and helps us stay fit and healthy. Whether you suffer from diabetes or are worried about weight loss or simply need to be energized all day, there is a special nutritious drink just for you!

So to know what is the recipe for your daily health drink, click here.

 

Worried about health insurance?

“Insurance Cos slash list of hospitals offering cashless services in Mumbai for making fraudulent claims”

“Medical insurers curb cashless facility”

“Mediclaim crisis looms, hospitals seek way out” 

“No more cashless mediclaim? Common man suffers”

Reading these headlines in local dailies, you, as a customer, both prospective and existing, must be really worried. After all, you had counted on health insurance to ride through the tough times of cash flow problems in event of hospitalization especially when medical inflation is so high. But all you see are hapless customers being denied first – the cashless claims and then- in some cases, even claims in general. Health insurance companies, you have found out, seem nice when you are buying a policy but when you make claims, they deny claims or double the renewal premium or discontinue the policies on renewal……

Before you think of your health insurance troubles more anxiously, we will try to give you a more balanced perspective about the scenario. All the headlines in dailies are not quite accurate about the situation. After all news is more about the unusual than the usual and media ends up talking about the rarities than the standard cases. As Health insurance experts, we give you our take on the current health insurance scenario.

You ask: Is Cashless Service no longer available? Have all Insurance Companies stopped Cashless facility? What’s the latest update on that front?

Cashless Service was discontinued by the four health insurance PSUs (Oriental, New India, United, National) from 1st of July 2010 from most of the hospitals in their network hospitals in the metros of Delhi, Mumbai, Chennai and Bangalore. The reason cited was - overcharging by most Hospitals and lack of standardized rates. Meanwhile, the PSUs were paying the reimbursement claims as usual. After weeks of hue and cry raised in media and inconvenience to the patients and negotiations, the hospitals and the health insurance PSUs have agreed on standardizing the rates based on the infrastructure available in respective hospitals. The hospitals have thus been divided into three groups based on the facilities.

It is agreed that cashless service will resume in 450 hospitals for 42 medical procedures that covers almost all common ailments from 20 August 2010 and there are talks of adding 350 more hospitals in the list.

The Bottom line:

  • Only the Public Sector Health insurance companies have discontinued the Cashless service in the four metro hospitals, you can still avail of cashless service in other cities or in private companies’ policies.
  • Cashless service is available for emergency and accidents cases in all the originally enlisted hospitals
  • Also, you need to check with your TPA to know the details of the cashless availability under your health insurance policy in the hospital you plan treatment in.
  • The Cashless service issue may be sorted out even further in few days.
  • Meanwhile all health insurance companies are accepting reimbursement claims.

You ask: Why all these sudden changes?

Health insurance cover

In the past 5 years, Health Insurance has grown to become the 2nd largest part of the total portfolio of insurance companies in India. Losses in this portfolio that could be ignored earlier have therefore now come significantly into picture.

In 2008-09 itself, Insurance companies paid 20 Lakh Health Insurance Claims worth Rs. 4087 Crore!  With overall Claim Ratio being 103%, Health Insurance companies paid more claims than the premium they took from their customers. Other expenses involved in managing the portfolio were adding to these losses. Since Government companies (PSUs) have 80% share of the health insurance market in India, they also bear the largest share of these losses. Also note that these losses are funded by ‘premium payers’ including people like you and me. In a predictable move, the Government companies are now under pressure from the Ministry of Finance to take active steps to get the health insurance business out of losses.  

Bottom line: These changes are made now because it is in recent times that health insurance has grown to such large proportions and become what it is, critical to the financial health of general insurance companies

You ask: How can insurance companies discontinue Cashless Facility? Is it legal?

Cashless facility has been incorporated in your health insurance for the convenience of the customers who find it difficult to arrange for large amounts of cash, required for hospitalization, especially in times of emergencies. However it has to be noted that it is an added service and not a core offering of the health insurance companies. The health insurance companies cannot change conditions in the policy without your consent; but they can modify features and benefits not forming part of the policy conditions. Also the PSUs did not discontinue the Cashless service; they only delisted some hospitals from their existing network and created a fresh PPN or Preferred Provider Network list. The list of hospitals does not form a part of your core policy conditions and hence the health insurance companies have arguably not done anything illegal.

Also you can still send your claims for reimbursement after you pay the hospital bills. You are still getting the core benefit of health insurance.

Bottom line: Cashless is not the core product, it is a payment mechanism. You can still avail of reimbursement claims and get your claim settled subject to policy coverage.

Health insurance claim

You ask: Are Genuine Claims also not paid?

Again this is misinterpretation by most, how can health insurance companies survive if they do not pay genuine claims? Plus, the entire cashless service controversy was a result of the soaring claims ratio (between 115%-130) for health insurance. That means for every 100 rupees you pay as premium, the company ends up with an outgo of 115 rupee.  This means that health insurance companies are slipping into losses because they are paying more than they are getting.

And unlike what the news that is circulating would like to tell you, in reality more than 95% of the claims submitted are passed with very small deductions. In order to get your claims settled without any hitch, read your policy document carefully to understand the conditions, keep the documents properly and submit the claim documents on time (for reimbursement claims). If you feel that your claim is being denied without proper reason, you can refer it back to the insurance company, then to insurance ombudsman and finally pursue the matter in consumer court.

Bottom line: If you have a genuine claim, it will be paid!

You ask: Are deductions made in an ad hoc manner?

There are times when you will find that TPAs/health insurance companies will not reimburse you the entire amount in the bill. But there will always be reasons for it- it may be because you have already made one or more claims in a year and the cover amount is spent (for ex. If you have already claimed  50,000 from your 2 lakh cover, you will be left with only 1.5 Lakhs during the remaining period of policy; and if you have a subsequent claim in the same policy year exceeding 1.5 Lakhs, you will naturally be paid only 1.5 Lakhs), there may be sub limits on the specific treatment (for ex: the cost of cataract should not exceed Rs. 25,000), there also may be some expenses that are not covered in your policy for ex. Service charges, admission fees, surcharges levied by the hospitals). In these cases the TPAs/Health insurance companies rightly deduct some amount from the final bill.

However, if you find that the health insurance companies have deducted an amount without valid explanation or reason, you may question them and even pursue the matter further.

Bottom line: TPAs/Companies cannot make deductions in an ad hoc manner as companies are bound by the insurance contract as contained in the policy, and TPAs, representing the Companies, need to process claims as per word and spirit of these contracts. While there are valid reasons for some deductions, you can fight them if you are not satisfied about the validity of any deduction.

You ask: If Insurance Companies can take such ad hoc decisions; they may do the same in the future.

Insurance companies cannot change terms of a contract, without your consent. Only features/benefits which were provided as customer service and don’t form a part of the terms and conditions can be revoked.

For instance,

-           From the informally accepted 30 days, recently many insurance companies reinforced the policy wordings clause of 7 day limit for submitting documents. This was a part of the policy wordings; only now this is being implemented rigorously.  

-           Hospital list does not form part of the core terms and conditions. Hence change of list of Hospitals is under the power of the Insurance Company.

-           Your feeling cheated is because any such change in the process does not get conveyed to you before such change is effected.

-            

Bottom line: In such a scenario, you need an expert in Health Insurance who would be able to inform, answer or provide you alerts on change in the “Value added, out of contract” benefits. And, for that matter, on all matters relating to Health Insurance.

Health insurance claims denied

You ask: Don’t the TPAs and Health insurance companies care about the customers?

In the entire cashless facility issue, if there is one party that was at the losing end, it was the customer. For more than a month now, they are forced to arrange for large sums of money to fund their treatments as Cashless was unavailable, some had to travel a great deal to reach the hospitals that remained in the PPN or Preferred Provider Network. It may look like Companies only care about their finances and that is the image that has been portrayed so far.

TPAs’ reputation is also getting a beating since they are primarily responsible for settling the claims. Health insurance companies are blaming the TPAs for being ineffective in curbing the losses and customers are angry that TPAs are being unfair to them. Abhitabh Gupta, CEO, Paramount TPA says “ TPAs cannot be blamed for the losses primarily because, most of the PSU Insurance companies had underwritten health insurance at an extremely low cost sometimes even selling Re. 1 policies, so it is but natural that they would suffer from losses. Further medical costs have been increasing at a rate of 10-15 % while the premiums are not increasing at the same rate.” He says that the TPAs weren’t given the rights to interfere on the line of treatment and unless there is some change in their role with more empowerment in these areas, TPAs can’t do much.

Here is how, this current cashless chaos will benefit you in the long run

The four PSUs chose to control the losses ahead of other insurance companies; otherwise the claims trend would put the fate of the entire health insurance industry at peril. Now that the hospitals have agreed to standardize their rates, the insurance companies will save at least 20-25% on their losses which will help the customers in the long run in terms of premiums not shooting through the roof.

Sudhir Sarnobat, founder of Medimanage Insurance Broking Pvt. Ltd, says, “Current churning in the market will make life very difficult in short term for all the parties involved, but once this phase passes, we are sure that the changes would be of long-term effect and would help the consumer”. He believes that the focused network with negotiated rates would improve the commercial feasibility of insurance and improve the quality and service delivery of hospitals. He says, “Once the losses are tamed, the journey is always upward in value and what is currently happening with the health insurance industry in India marks the beginning of this”.

Also, another point we need to consider is that premiums of health insurance companies have not risen in the ratio of medical inflation which has created the divide between claims and premiums earned, so health insurance essentially remains quite affordable and inexpensive in comparison, even after these changes. Thus buying a health insurance policy for yourself and your family even now seems a very good idea.

Bottom line: Irrespective of the controversies, health insurance policy is a must investment for every family, it is the only savior during difficult times and even now, considering all the recent changes and available options, it remains a safe investment.

personality type A diet

If you simply thought that your job or lifestyle was the only reason for your ill health and unhealthy eating habits, well here’s news for you. You personality type could also be the reason for you being stressed and wrong eating!

Type A personalities have a rushed, angry and reactive kind of behavior and highly stressed lives. They are supposedly are more prone to diabetes, hypertension, nutritional deficiencies and other such stress related problems. They usually tend to have irregular meals, binge at unusual times and consume loads of alcohol. For the same reasons they tend to be irritable, impatient and have disturbed sleep.

They are recommended a different kind of diet by nutritionist Madhuri Ruia.

She suggests that their diet should contain higher vitamin C, lesser sweet foods and caffeine; more regular wholesome meals and regular exercise to burn cortisol, the stress hormone.

To see the complete diet plan click here…

 

New India Assurance Launches premium Mediclaim product

MUMBAI: Leading state-run general insurer New India Assurance Company today said it will soon launch a new premium Mediclaim product as a part of its efforts to resolve the issue over the cashless health cover, which the state-run players had discontinued early July alleging inflated billing by hospitals.

The move is also aimed at bringing corporate hospitals under its fold, Ramadoss said, adding it is adding three Delhi-based leading corporate hospitals-Gangaram, Max and Medicity to its empanelled list of hospitals for this scheme.

The IRDA Chairman's remarks came a day after the Delhi High Court asked the insurance regulator to sort out the imbroglio over the cashless facility to policyholders in major hospitals across the country. The regulator, however, held the view that it could do nothing in this regard.

"We have long moved away from the administered price regime and it is for the market forces to determine the price of their products," Narayan further said, adding there might be co-payees or higher premium products for these five-star hospitals, which the insurers should decide.

Clarifying on the PSU insurers' recent decision to discontinue cashless policies, Ramadoss said, the company was never against cashless claims but wanted some clarity on the tariffs being charged by most of the hospitals empanelled, which the insurance industry felt were inflated.

To read full news, click here

Experts from Medimanage.com give their opinion:

Sudhir Sarnobat:  

Sudhir Sarnobat from Medimanage.com

Though the idea may sound promoting the Free Market regime, there is inherent flaw in the thought process.    

  • In India, when the insurance is still not reached to masses, we are already jumping to provide benefit for Class. This way, we are also promoting the thought of luxury lifestyle in healthcare when thousands of people do not have basic access to healthcare.

 

  • How an ordinary person will know when he will need treatment at “Premium Corporate Hospital” hospital? The basic mistake is in classifying these hospitals as “Big Corporate Hospital”. They are tertiary care hospitals & are competent to handle complex cases. A person cannot predict when s/he will have disease that can be treated only at such hospitals. Then how such person will decide in life whether to buy such product or not.

The insurers should classify the ailments as primary, secondary & tertiary care and then accredit the hospitals on same basis. Then insurer could define the rates at such hospitals & ensure that quality treatment is made available at such hospitals for given price. If the customer still wishes to go to Tertiary care hospital (as per insurers, Big Hospital), s/he can do so but should be paid only the amount that one would spend at secondary or primary care hospital.

Mahavir Chopra:

Mahavir Chopra from Medimanage.com

I agree with Sudhir.

When does a common man like you and me take decision of going to a Corporate Large Hospital. It’s in most cases when the case is complex or an emergency. Like Purandar once said, If someone suffers from a stroke he needs to be taken to a place where an MRI can be carried out. He cannot avoid going to a large hospital just because his policy does not cover this hospital.

The mass population does not look at going to a large hospital for small surgeries like a cataract of a hernia operation, he/she would go to a local nursing home through reference of his/her general physician. What is being done here is penalizing everyone for some people with hideous intentions to misuse the insurance for cashing the best out of the coverage. More scientific caps/limits to common treatments would help in getting control over such claims. In addition to room rent limits which already brings in some amount of control, the associated costs increase due to higher room rent should be brought under capping under the policy wordings.

 
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