Why we do not need ‘Claim Ref’?

health-insurance1A few days ago The Hindustan Times in New Delhi reported that the global acturial company Milliman has ‘launched ‘claims processing guidelines’ that enables a third party administrator (TPA) or insurer to determine the severity of a patient’s condition and identify if the length of hospital stay investigations, consumables and treatment procedures are more than what is typically required’. 

The product reportedly called ‘Claim Ref’ can apparently be linked to a software, which allows it to compare a claim made by a hospital, with a ‘typically’ similar case taken out from a database containing information about 125 procedures gathered from Indian hospitals. This simply means that the insurance companies can hold back payments to the hospitals if the claim amount is in excess of what ‘Claim Ref’ indicates.

I am hugely skeptical of such arithmetic modelling for the following reasons.   Continue reading

The Terror in Mumbai

taj-on-fire I am shocked and bewildered at the audacity of the terrorists in Mumbai, who are holding the country to ransom. As the gruesome drama unfolds live on television channels going berserk, one is left wondering at what might be some of the consequences of this dastardly act.

I woke up this morning to the headlines in the Hindustan Times about terrorists striking in Mumbai and having killed more than 100 people in random firing at public places including the crowded Railway Station, busy hospitals, beaches and finally taking hundreds of people hostage in the landmark Taj and Trident Hotels in downtown Mumbai. Switching on the television, brought the tragedy and horror to ones bedroom.   Continue reading

Alok Singh

I first met Alok Singh last month at his office in Andheri East, Mumbai. Alok was working as the station head for Fever 104 FM, a FM radio station owned by the Hindustan Times group. The station has been struggling and Alok had moved in from Kolkata a few months back to set things right.

I was visiting the Mumbai station on my induction. As a new employee I was required to visit all the stations (Fever 104 runs stations in Delhi, Mumbai, Bangalore and Kolkata), meet key people and understand the finer points of the Radio business. That morning Alok filled me in on the company’s history and his own professional life. In an earlier life he had worked for Pepsi and Vodafone and had gone to the Indian Institute of Management in Lucknow for his management education. I was suitably impressed. We talked about the difficulties of shifting to Mumbai and being an outsider in Mumbai in these times of Raj Thackray and his goons.    Continue reading

World Heart Day

Today is the World Heart Day.

World Heart Day is observed the world over on the last Sunday of the month of September. World Health Organisation estimates that annually over 17.5 mn people die of cardiovascular diseases. It is the world’s largest killer.

The theme of this year’s World Heart Day is ‘Know Your Risk’. Heart Disease is largely a consequence of the lifestyle choices that we make. True, some of us are predisposed to this disease because of our genetics, many of us make unwise lifestyle choices and suffer the consequences. Diet, Exercise and avoiding smoking are the simplest ways of keeping heart disease at bay. Yet so few of us pay attention only to regret later.   Continue reading