Health Insurers Vs. Hospitals-Patients Pay

So the health insurance companies have started tightening the screws on private hospitals in India.  The tussle between health care services providers and the health insurance companies have been on the cards for a while now. The sordid affair burst into the limelight last week, when India’s 4 largest general insurance companies, all owned by the government of India, refused cashless services to patients in these hospitals. The insurance companies can easily do this, by throwing out these hospitals from the network of hospitals, whose patients are entitled to this benefit. The fine print that you and I sign, while buying an insurance policy says that we are entitled to cashless services in select hospitals only and the insurance companies can change this network at their sweet will.

Well, for the uninitiated here is what the problem is. Health Insurance companies believe that hospitals overcharge patients who have an insurance cover simply because the money is to come from the insurance companies. Insurance companies for long have been asking hospitals to agree to fixed rates for some common procedures and surgeries. The hospitals have been resisting this as they believe that these rates are too low and in medicine, it is quite impossible to have fixed packages for surgical procedures etc. Large private sector hospitals, who offer high standards of medical care and pride themselves on their state of the art equipment, doctors, nurses etc. believe that at the rates offered by these PSU insurers, they will not be able to maintain their standards and lose money. Thus the impasse.

Now, here is the truth. The insurance companies by and large are right in accusing the private hospitals of overcharging patients who have an insurance cover. However, in many hospitals this is not deliberate. It is just that if a doctor is in doubt about ordering a test, he invariably would ask for the test, if the payor is not the patient but is an insurance company. This is largely because he wants to be sure of his diagnosis and reduce the risk of his clinical judgement being wrong. Now one may argue that the additional test, constitutes better healthcare and the doctor is well with in his right to ask for it and viewed from this perspective, this would hardly qualify as ‘overcharging’.

The other reason for inflated bills is that we as consumers do not feel the pinch even if the hospital bill is more than what we had thought it might be at the beginning of the hospitalisation. Since the insurance company is paying we would insist on top of the line stuff for ourselves. It hardly matters, whether we really need it or a cheaper option might have been just as effective, things that we would surely consider if we were paying out of our own pocket.  I recall when my father underwent a prostate surgery last year, we ran up a bill of close to Rs. 200000, which I thought was on the higher side. However, since we had insurance, I hardly felt the need to either question the doctor or the hospital. I believe, mostly this apathy of the hospital as well as the consumers towards insurance payouts inflates the bills.

Apart from inflated bills the insurance companies also believe that hospitals defraud them by manipulating patient histories and making claims on behalf of the patients, who would otherwise be ineligible for the claim. This mostly happens if a patient has a pre-existing condition (ordinarily not covered), which the hospital’s doctors would try to hide from the insurance companies. Well, there is a grain of truth in this as doctors occasionally do try to ‘help’ their patients. This is mostly on the request of patients, who desperately want to make a claim even when they know that they are not eligible. The doctors try to oblige their patients either because they have an existing relationship with the patient or when they fear that if they do not ‘help’ the patient he will go to another doctor, who will do the needful. Thus losing a patient for something like this makes little sense to them.

The insurance companies on the other hand are always looking at ways and means of denying hospitals claims, which are perfectly payable. They arbitrarily make deductions citing obscure and often questionable reasons. Many a times they release the hospital’s payments without even informing them that they have deducted part of the money. The payments are rarely made on time, the third-party administers (TPA’s) working for the insurance companies are given targets to reduce payouts to hospitals and the system is  hugely inefficient. Hospitals have to incur costs by hiring people, whose only job is to follow-up with the insurance companies and TPA’s about the money owed to them.

A summary cessation of cashless facilities in private sector hospitals is hardly the solution that works. The insurance companies need to work together with the hospitals to sort out their differences on a case to case basis. The hospital as well as the insurance companies must appoint reasonably experienced and mature people to manage these relationships, who should regularly meet and discuss all cases, where the insurance company feels that the hospital has overcharged. These cases should be thoroughly investigated and if a doctor is found complicit, he should be asked to explain. The insurance companies and the hospitals should organise training programs for the doctors, making them aware of how ‘helping’ patients helps no one. If the insurance company finds a hospital’s administration itself involved in shady practices than of course they must throw the hospital out of their network. On pricing, the insurance companies must accept that hospitals have a right to price their services as they deem fit. Most hospitals will price themselves according to the quality of their services, the pull of their brand and the existing market realities. The insurance companies must accept these prices and maybe they can ask for some discounts based on the volume of business they conduct with a particular hospital. Dictating prices to a hospital is bad policy as the hospital when squeezed hard will cut corners thus compromising on patient care.

Finally as consumers, it  also devolves on us to be more prudent about our healthcare spends in a hospital. We should be as careful with the insurance money as we would be with our own. If we don’t and the insurance companies keep bleeding we will either end up paying higher premiums or worse, will have no cashless services in spite of having an insurance cover.   

 

 

Sikkim-The Jewel Hidden in the Mountains-III

We reached Yuksom late  in the afternoon, quite famished and Jeewan quickly drove us to a hotel, where we ordered lunch. While the lunch was being prepared, we decided to go up to the Throne of Norbudong, the site of the coronation of the first ‘chogyal’ (king and spiritual leader) of Sikkim. The Throne of Norbugang, witnessed the crowning ceremony of Phuntshog as the first king of Sikkim in 1641 AD. The ancient throne today stands with in a rubble enclosure, facing East and comprises of four stepped seats. The largest of the four seats, right in the centre was for the great Nyingapa Lama Lahatsun Chembu, while the seat to his right was for the chogyal.The other two seats were for kartokpa lama Sempa Chembo and kartokpa lama Rigzig Chempo. The throne is sheltered by a huge pine, which stands like an enormous sentry guarding the throne.We wandered around the Throne of Norbudong, explored the chorten nearby and rotated a huge prayer wheel. The yellow and white prayer flags fluttered in the breeze and we felt a wonderful peace enveloping us.

Yuksom is also at the head of the Kaziranga National Park and the trek to the base of the mighty Kanchanjunga starts from Yuksom. Thus, Yuksom attracts trekkers and mountaineers from across the world. It is an enchanting village surrounded by lush forests and high mountains, with wild flowers growing everywhere. Had we researched this trip better, we would have certainly stayed a couple of nights in Yuksom. We returned, had lunch and with a nagging dread for the landslide we had encountered earlier, we left Yuksom.

As we once again approached the 1.5 kms stretch of road, which the landslide and the rains have converted into a veritable bog, we girded ourselves up. Jeewan said a small prayer and we plunged into the mud, with Jeewan flooring the pedal and the car zig-zagging its way across the slush. We would have hardly covered 500 m, when we got stuck, with the rear wheels of the car uselessly grinding in the mud. The harder Jeewan tried to extract us from the bog, the deeper we appeared to be sinking.

Fortunately for us there was a gang of workers who were around. While on our way up to Yuksom, we had seen them at work trying to fix the road. Now with the sun going down, they were done with a hard days work and were squatting by the roadside smoking and chatting. Seeing our predicament they offered help. About half a dozen young men tried pushing us out of the rut. Jeewan would floor the pedal, while these young men would try to push the car out. We tried this for over half an hour, but with little luck. Finally in a bid to increase the weight at the back of the car we all piled in from the back-door, and some of the lads on the road jumped on to the car’s rear, while others pushed hard with Jeewan pouring all the car’s power, we zig-zagged our way out of the mud. We all breathed a big sigh of relief, profusely thanked the boys, without whose help we did not stand a chance.

On our way back to Pelling, I could not help but wonder at the generosity and spirit of these native people, who after a day’s toil did not think twice of helping people like us in distress. None of them ever flinched from joining in knowing fully well that this was an arduous task and that they would soon be covered with mud and will have to wash again. Not only did they come for help, they did so with grace and a great deal of laughter and fun. As they waved us on, they were all smiling at a job well done. Wonderful people.

The next day, our last in Sikkim, again dawned overcast with the clouds swirling on the streets. Any hopes of catching a glimpse of the Kanchanjunga receded. We headed off towards the Pemayangtse Monastery, located 3 kms above Pelling. The monastery was established by Lama Lahatsun Chembo and is considered to be one of the oldest monasteries in Sikkim. We climbed up to the monastery amidst yellow prayer flags dancing in the mist. Pemayangtse Monastery contains rare Buddhist artifacts, the walls are covered with fine murals, old sculptures and ancient scriptures adorn the first and the second floor of the monastery. On the top floor we saw a magnificent wooden structure, a seven tiered depiction of the heavenly palace of Guru Rinpoche. The monastery also afforded a beautiful view of distant hills, flowing streams and the ruins of Rabdentse, the second capital of Sikkim.

Tensung Namgyal, the second chogyal of Sikkim and the son of Phuntshog Namgyal, shifted the capital of Sikkim from Yuksom to Rebdantse, which is located on a significant spur, within a thickly forested valley, South West of the Pemayangtse Monastery. Wewalked about 1.5 kms through an enchanting forest to reach the ruins. The walkway gradually slopes upwards and the ruins are close to the top and are immaculately maintained. A dividing wall clearly highlights the areas used by the royals and the ones meant for lay religious ceremonies. As we explored these ruins, we could not help but notice their beautiful environs, surrounded by a dense jungle, a beautiful valley below us, distant hills beyond the valley and clouds flitting around us. Suddenly the sun broke through and it drenched everything in such bright light that we found ourselves squinting. The three Chortens, inside the royal quarters right on the edge of the hill stand proud and erect and one could clearly see the monastery higher up on the opposite hill. Rebandtse remained the Sikkimease capital till 1780, when it was attacked by the Nepalease. The chogyal Tenzing fled to Tibet and it was only in 1793 after the Sino- Nepalese treaty  was signed that his son Tsudphud Namgyal returned to rule Sikkim once again. He decided to shift the capital to Tumlong, further away from Nepal and thus gradually Rebandtse turned into these ruins.

Since we still had half a day left, Jeewan decided to drive us to the Singshore suspension bridge, which is located near Dentam some 25 kms from Pelling. The bridge is an engineering marvel and connects two densely forested hills. It is over 100 m high and spans, without support over 20o metres. The bridge affords a breath-taking view of the hills with waterfalls everywhere. As we stood on the bridge we could feel the wind in our hair, the thrill of being suspended high up in the air between two magnificent mountains and it was magical. We had delicious momos at the food stall adjacent to the bridge and decided to climb up further to the village of Uttarey, beyond which lies Nepal. The ride to Uttarey was wonderful and the village itself is a tranquil hamlet. We were running out of time and had to return to Pelling by the evening.  Thus, we descended quickly to the Singshore bridge and drove over it on our way back to Pelling.

The next day we departed Pelling early to catch our flight at Bagdogra. Jeewan saw us off at the airport. All of us carried wonderful memories of Sikkim, a land of great grandeur, unspoilt and virgin, full of kind and gentle people. We did not get to see Kanchanjunga, but then it is a fickle mountain and one can not do anything, if it chooses not to reveal its secrets. We would in due course return to seek the mountain’s blessings at a more opportune time.

Concluded

Sikkim-The Hidden Jewel in the Mountains – II

An overcast morning in Sikkim

We left Gangtok for Pelling on an overcast morning. Jeewan Alam, our driver turned out to be a loquacious and feisty young man, full of life. As we drove to Pelling in West Sikkim, Jeewan Alam talked about life in Sikkim. Jeewan has two elder brothers in the armed forces, one posted in the North Sikkim mountains and the other with the Assam Rifles in Assam. He too wanted to follow in his brother’s footsteps, but his mother intervened, asking him not to go fighting to distant borders and stay with her to care for her in her old age. Jeewan, thus became the owner and the driver of this Tata Sumo, which he had bought second hand. He loved the car, was very proud of it and lavished good care and attention on it through out our travels with him. In addition to the Tata Sumo, he also owned a Mahindra Bolero, which was also being used as a taxi and was driven by a friend of Jeewan.We again drove along the Teesta, and as we went down the mountain from Gangtok, the sun came out, the clouds vanished and our hopes of seeing the Kanchanjunga, in Pelling went up. We crossed the border at Rongpo and entered the hills of West Bengal, followed the Teesta to where it met Rangeet and than traveled along the Rangeet, in West Sikkim. Rangeet forms the border between the turbulent hills of West Bengal and the peaceful  surrounds of Sikkim. Jeewan has a deep rooted sense of disquiet about the hill folks of the neighbouring Darjeeling. He believes that most of them are aggressive good for nothing sorts, who come into Sikkim only to create trouble. We went past Melli, Jorethang and Legship, from where we started our ascent to Gaeyzing and finally Pelling.

Rimbi Waterfalls Pelling

Pelling is situated on a ridge atop a forested hill facing the Kanchanjunga. As we had driven up from Legship, clouds had again rolled in and completely enveloped Pelling. We reached Pelling late in the afternoon, had lunch and decided to rest in the hotel.The next day we set out early in the morning for Yuksom, the ancient capital of Sikkim. Jeewan promised to show us the countryside, en route. Our first stop was the Rimbi waterfalls, located 12 kms from Pelling. The water of the Rimbi river falls down a steep hillside completely covered in green into an inviting

Fisherman on the Rimbi

pool and then flows into a stream. A small hydel power plant is situated on the left bank of the Rimbi river and provides power to Pelling and other nearby villages and towns.The department of tourism in Sikkim has developed the Sewaro Rock Garden on the banks of the river Rimbi. The park is beautiful with wildflowers growing everywhere in abandon, the Rimbi river flowing by majestically and the hills completely covered with lovely forests on either side of the park. Somehow, the place reminded me of Pehalgam in Kashmir. We walked along the swiftly flowing river, watching an indigenous tribal fishing, by fording the river and throwing his small net in a wide arc. As he drew in the net, he would let go of the smaller fish and only take the bigger one as his catch.

Returning from the Sewaro Park, we headed for the famed Khecheopari Lake. The lake is situated at 6000 ft and is considered to be holy. Legend has it that many years ago, the lake was a grazing ground full of thorny nettles. The Lepchas used the barks of these trees for medicinal purposes  and once, while a Lepcha couple sat peeling off the bark , they witnessed two huge Conch shells hitting the ground with tremendous force. The ground than shook violently and a stream of clear water emerged, which engulfed the entire surrounding area, thus creating the

Khecheopari lake

lake. The lake has since been recognised as the abode of ‘Tshomen Gyalmo’, the chief protective nymph of the dharma and blessed by the goddess Tara. The walk to the lake is through a winding path in the jungle alive with beautiful wild flowers, ferns and huge trees standing erect and proud. The lake itself is hidden behind colourful prayer flags and a long jetty allows pilgrims to reach out to the lake. As we walked up to the lake, we had pilgrims carrying incense sticks and other puja paraphernalia, jostling with each other. Right at the end of the jetty, the devout prayed and offered ‘prasad’ to the lake, which was quickly gobbled up by a school of fish, thrashing about in the lake.

Kanchanjunga Falls, West Sikkim

We left Khecheopari Lake by early afternoon and it had started drizzling. Sikkim’s roads are prone to sudden closure because of landslides and Jeewan was worried about us being able to reach Yuksom and return to Pelling by the evening. On our way to Yuksom we had one more scheduled stop at the Kanchanjunga Falls. After witnessing our excitement at the Rimbi Falls, Jeewan had been hinting about the Kanchanjunga Falls being far more exciting. The name itself conjures up images of the water coming down from the snowcapped peaks of the great mountain and I must say on seeing the waterfalls, we were left speechless. The main falls are hidden from view from the road and we had to walk about 500 m to view the spectacular waterfalls, a huge wall of roaring water crashing almost vertically from 150 m or more, surrounded by dense foliage and moss covered stones. We also noticed that for some reason we were alone at the falls and even the tea shops around the picturesque spot were shut. We soon discovered the reason-the word had been passed along that the road to Yuksom had been closed because of landslides and thus other tourists had already returned to Pelling.

As we thought about this unexpected turn of events, Jeewan sensed our disappointment and chipped in by saying that “let us carry on towards Yuksom and we will return only if we found the passage completely blocked”. We quickly clambered aboard and once again set off. About 10 kms ahead we ran into the landslide. The stretch of the road about 1.5 kms long looked like a sea of mud with a huge gorge on one side. A gang of workers were busy trying to make the road passable but they were clearly no where near finishing their task. Jeewan decided to wade into this.  With his foot firmly on the accelerator, the car lurched ahead with a vengeance and skidded dangerously. Jeewan kept pressing ahead, struggling with the car, trying to keep it on the straight and the narrow. I do not know how, but we did manage to shoot through the slush and found the macadam once again. We all lustily cheered for Jeewan and his boyish zeal to show us around his Sikkim and continued to Yuksom, the first capital of Sikkim.

To be contd.

Pics by the author

Sikkim-The Hidden Jewel in the Mountains-I

The Prayer Flags

Sikkim is perhaps India’s best kept secret.  It is a tiny state quietly nestled into the Himalayas and is arguably the most verdant with the widest diversity of flora and fauna in such a small landlocked area. We traveled to Sikkim earlier this month. Sikkim has no airports nor is it connected by a the railways. We flew to Bagdogra, which is the nearest airport to Gangtok, the capital of the state and then drove from there to Gangtok.

The drive to Gangtok is along the Teesta, a tributary of the mighty Brahmputra.  As we wound our way to Gangtok, hugging the hillside on serpentine roads, Teesta flowed in the beautiful valleys below us. Teesta ia a large river, flows swiftly down from the Cholamo Lake (over 17000 ft in the Himalayas), is joined by numerous rivulets and the Rangeet on the Sikkim – West Bengal border to eventually reach the W. Bengal plains at Sevoke near Siliguri.  We entered Sikkim at Rangpo, the south Sikkim town adjoining West Bengal and carried on for another 40 kms to reach Gangtok by the early evening.

Gangtok I must confess is unlike any other hill town that I have seen. Unlike the bustling hill cities of North India (Shimla, Nainital, Mussorie even Manali), Gangtok is infinitely more orderly. At close to 5000 ft, in the Eastern Shivaliks, Gangtok is spread over several hills. A nice sidewalk with a railing snakes across the city for pedestrians to use, the traffic is orderly and we never encountered a traffic jam during our stay. The taxi from Bagdogra deposited us at a taxi stand meant for tourists coming from outside Gangtok, we transferred there to a local taxi, which took us to our hotel. There were no taxi drivers chasing us for a fare, there were no touts usually hired by local hotels shoving and jostling and falling over themselves to escort us to a hotel. If you have been to any of the North Indian hill stations, you would understand what I mean.

The Prayer Wheels

Gangtok is well-known for its Buddhist Monasteries. The Enchay Monastery, which was set up in 1840 established Gangtok as a prominent Buddhist place of pilgrimage. In 1894, the local ruler under the British moved the capital from Tumlong to Gangtok. After India’s independence Sikkim became an Indian protectorate . In 1975, following a popular uprising and a request from the Sikkimese Prime Minister, Sikkim became a state of the Indian Union with Gangtok as its capital.

In Gangtok we visited the famous Duddul Chhoedten Stupa, built by Trulshig Rinpoche, a holy lama who came visiting from Tibet. It is said that this place was earlier haunted by cruel spirits, who regularly assaulted people visiting the site. Lama Trulshig Rinpoche subdued the wandering spirits and built this Stupa and a hermitage. Today the stupa is a bustling centre of Tibetology, with hundreds of resident monks and colourful Tibetan prayer flags fluttering in the wind and people from all over India and indeed the world visiting to pay their respects.

The Namgyal Inst.

Adjacent to the Stupa is the Namgyal Institute of Tibetology, which houses rare artifacts, manuscripts, paintings from the 17th – 19th century. It is the leading research institute in Tibetology and promotes scholarly research in the history, religion, art and culture of Tibet. We visited the museum and were awestruck by its exhibits and wondered at the labour of love that this institute really is.

On our way back we went on a rope-way ride, which connects the Gangtok market place with the secretariat. It afforded great views of the city as it quietly made its way to the state secretariat and returned after a brief stoppage.

On an overcast day with the clouds floating all around us we visited the Rumtek Monastery, located at 1500 mts and about 24 kms from Gangtok. As we reached Rumtek after a pleasant drive through the forested hills, the skies opened up. We took shelter at the chai shop near the taxi stand, rented umbrellas from the shop owner and walked up to the monastery. Rumtek is the largest monastery in Sikkim and was built-in the 16th century by the 9th Karmapa Wangchuk Dorji. It is the seat of the Karma Kagyu sect of Tibetan Buddhism and was rebuilt by the 16th Karmapa, when he escaped from Tibet and took refuge at the ruined monastery in 1956. Rumtek Monastery is a quiet place, nestled amongst verdant mountains, distant snow peaks and flowing streams around it.The Dharma Chakra Centre and the Karma Shri Nalanda Institute at the monastery is a centre of learning with many resident monks studying Tibetan Buddhism.  Inside the monastery is a Golden Stupa, which houses the holy remains of the 16th Karmapa HH Rangjung Rigpe Dorje. While, we stood in the huge courtyard of the monastery, we could hear the rhythmic chants of the monks, and the blowing of the musical instruments, and the beating of the gongs inside the main hall of the monastery. By the time we decided to return, the rains had stopped, the clouds had cleared up and across the valley we could see the city of Gangtok spread out on the opposite hill.

The Ranka Monastery

Ranka Monastery is a relatively new monastery but in grandeur it surpasses all the monasteries I have seen so far. The monastery is on a spur facing the Gangtok hills and rises magnificently. Murals with Buddhist themes are painted on the walls and in the courtyard stands a wishing column with a small ledge near its top. It is said that if one was to throw a coin and asks for a wish, it gets fulfilled if the coin remains on the ledge.  The day we visited the monastery, we saw prayers underway with rows of monks sitting together, chanting the sacred Buddhist texts. The atmosphere at the monastery with clouds hanging low and flitting across the courtyard, the monks and the chants all making this an ethereal experience.

The Ban Jhakri falls on the outskirts of Gangtok are magnificent waterfalls, which the government has converted into an Energy Park.

The Banjhakri Falls Gangtok

The park is well laid out with pedestrian foot bridges, ‘çhatris’ and dragons. Jhakris in tribal lore are Shamans, with magical powers. Ban Jhakri is a pagan shaman, who kidnaps children believed to be pure of heart and initiates them in the Tamang rituals. The story of Banjhakri is told through sculpture and figurines laid out in the park.  A splash pool for children at the park is adorned by a dragon.

Gangtok is also known for its magnificent views of the Kanchanjunga, the third highest mountain peak in the world and the highest in India. Mr. Lama at the hotel, while escorting us to our rooms, had pointed in the direction of the peak and had said that one of these days we will see the mighty mountain right from our window in the hotel room. Alas, all during our stay in early June we could not see the Kanchanjunga because of the monsoon clouds hovering over the mountains. We went to various Kanchanjunga view points to catch a glimpse of the mountain but our luck did not turn.

Giving up on Kanchanjunga and hoping to catch it at Pelling, we left Gangtok, happy and delighted to have enjoyed our stay in the town. We met Jeewan Alam, who quickly loaded our gear on the roof of his trusted Tata Sumo and off we went on another adventure.