羊毛。。。

NewFuture

出在羊身上。。。


http://m.todayonline.com/singapo ... -third-party-agents

Doctors cry foul over ‘unfair’ practice of third-party agents


SINGAPORE — They typically help companies handle the healthcare insurance claims of employees, and help insurers manage claims for healthcare expenses.

But lately, third-party administrators (TPAs) are wedging themselves between doctors on their panel and individual patients on various Integrated Shield plans.

The TPAs are charging doctors administrative fees for “referral” of these patients, when they could have played no role in the patient going to the doctor.

The TPAs, who represent insurers, would write to the doctors in private practice and claim fees ranging from 8 to 25 per cent of the doctors’ professional fees. Doctors are questioning the basis and ethics of this practice, which could ultimately hurt the quality of care for patients.

The practice was raised by geriatrician Carol Tan on Friday (June 10) at a conference on keeping healthcare costs sustainable.

Factors that contribute to escalating healthcare costs include business costs, which incorporate the administrative “referral” fees that TPAs are charging doctors.

These TPAs — also called managed care companies — are representing insurers and yet, are asking for payments from doctors, she noted.

“There’s a role for managed care; the issue is what does that managed care organisation do,” said Dr Tan, who chairs The Good Life Co-operative, which held the conference on Friday in collaboration with the Life Insurance Association Singapore, and reinsurance firm Swiss Re.

Three other doctors confirmed this practice, and two said they only came to know about it this year.

There are subtle differences in the practices of the four to five TPAs, they said.

Those affected are mainly specialists in private practice, as Integrated Shield plans are for hospitalisation.

The Singapore Medical Association (SMA), which represents the bulk of doctors here, said it is aware of the TPAs charging for the “referral” of patients with Integrated Shield plans or various managed care schemes.

SMA president Wong Tien Hua said: “The SMA is deeply concerned that when such admin fees are based on a percentage of what the doctors charge their patients, it can be interpreted to be fee-splitting or a commission paid to these agents. SMA is against such practices because they are against the best interest of

patients.”

The administrative fee charged by these TPAs should be based on their work and resources, not on the fees charged or work done by the doctor, added Dr Wong.

Patients and clients of these agents should be made aware that such fees are being paid, he said.

The SMA has sought clarification on the issue from the Singapore Medical Council, and is awaiting “definitive advice” from the medical watchdog, said Dr Wong.

Two private specialists told TODAY that clauses were added to their contracts with the TPAs, which they were unaware of until the latter claimed fees from them.

TPAs’ restrictions on the amounts doctors can charge their corporate patients were extended to the Integrated Shield policyholders of the insurer they represent.

Doctors said that they already have to follow stipulated fees that can be very low, and these fees are further creamed off by admin fees to TPAs.

There should be an absolute cap on administrative fees charged, a specialist added. Some stipulated fees imposed by TPAs for consultation or surgery can be half the amount specified in SMA’s fee guidelines a decade ago, she said. “It’s ridiculous.”

In 2007, SMA’s fee guidelines were removed over anti-competitive concerns.

Already, some senior doctors have pulled out of the panels — which could have implications on patients’ access to quality care, the doctors said.

Despite the unfairness, other doctors remain on the TPAs’ panels because of the competitive business climate, they said.

NewFuture

One TPA has contract clauses denying doctors the right to sue, or imposing a long notice period before being able to pull out of the panel, said another specialist.

It is fair to not want doctors to overcharge — although this happens only among a few bad apples, said Dr Tan.

Surgeon Dr Ho Choon Kiat suggested insurers talk directly with doctors on reasonable price ranges for various procedures.

But relief could be in sight, and such practices by TPAs could be curbed.

Speaking immediately after Dr Tan’s welcome address at Friday’s conference, Minister of State for Health Chee Hong Tat said he did not yet know enough about the practice to comment specifically.

“But if it doesn’t add value and it’s just a parasitic activity, it just adds on to cost, we should not allow it,” he said.

NewFuture

醫生喊冤了第三方代理的“不公平”的做法


新加坡 - 他們通常幫助企業辦理員工的醫療保險理賠，並幫助保險公司管理對醫療費用報銷。

但是最近，第三方管理員（第三方協議）是其面板上的醫生和患者個體對各種集成屏蔽計劃之間楔入自己。

該第三方協議收取的醫生行政事業性收費對這些患者的“推薦”，當他們可以發揮在病人去看醫生沒有作用。

該第三方協議，誰代表保險公司，會寫私人執業和索賠費用從8到醫生的專業費用25％的醫生。醫生們質疑的基礎，這種做法，這可能最終傷害了患者治療質量的道德。

這種做法在保持上醫療費用持續的會議上週五（6月10日）上調了老年醫學專家卡羅爾·譚。

有助於不斷上升的醫療保健費用的因素包括企業成本，其中納入了第三方協議收取的醫生管理“引薦費”。

這些第三方協議 - 也被稱為管理式醫療公司 - 是代表保險公司，然而，所要求的從醫生的付款，她指出。

“有對託管保健作用;問題是什麼呢，託管保健組織做的，“Tan博士，誰主持美好生活合作社，它與生命保險協會新加坡再保險公司瑞士再保險公司合作，以及上週五舉行的發布會上說。

其他三個醫生證實了這種做法，和兩個說，他們只來了今年來了解它。

有在四到五個第三方協議的做法細微的差別，他們說。

這些受影響的主要是私人執業專科醫生，如集成屏蔽計劃是住院治療。

新加坡醫藥協會（SMA），在這裡代表了大部分醫生說，它知道第三方協議收取的患者集成屏蔽計劃或各種管理式醫療計劃“推薦”的。

SMA總裁王田華說：“SMA深感關切的是，當這樣的管理費是基於什麼樣的醫生收取病人的百分比，它可以被理解為分錢或支付給這些代理佣金。 SMA反對這種做法，因為他們反對的最佳利益

患者“。

這些第三方協議收取的管理費，應根據自己的工作和資源，而不是由醫生進行收取的費用或工作，加入黃醫生。

這些藥物患者和客戶應意識到正在支付這些費用，他說。

該SMA尋求從新加坡醫藥理事會問題的澄清，並從醫療監視等待“權威意見”，黃醫生說。

兩個私人專家告訴今天的條款添加到其與第三方協議合同，他們不知道，直到他們從後者聲稱費。

第三方協議“的金額限制，醫生可以收取他們的企業患者擴展到他們所代表的保險公司的綜合盾投保人。

醫生說，他們已經按照約定的費用，可以是非常低的，而這些費用由管理費進一步挑選出來給第三方協議。

應當有收取行政事業性收費的絕對上限，專家補充道。通過第三方協議進行諮詢或手術所帶來的各種規費可以在半年均線的指引費十年前指定的金額，她說。 “這是荒謬的。”

2007年，SMA的收費準則，在反競爭的擔憂刪除。

目前，一些資深醫生拔出了面板的 - 這可能會對患者獲得優質護理的影響，醫生說。

儘管不公平，其他醫生留在第三方協議“，因為競爭激烈的商業環境中板，他們說。

一個TPA有合同條款拒絕醫生提起訴訟的權利，或能夠拉出面板之前施加長的通知期，另一個說專家。

這是公平的不希望醫生濫收費用 - 雖然這僅發生之間的幾個壞蘋果，陳醫生說。

外科醫生何浚博士永吉建議保險公司與合理的價格範圍為各種程序的醫生直接對話。

但是，救援可能是近在眼前，並通過第三方協議這種做法可能被遏制。

上週五的發布會上陳慶炎博士的歡迎致辭後，立即來說，國家衛生慈康達部長說，他還沒有足夠了解的做法具體評論。

“但是，如果它不增加價值，它只是一個寄生的活動，它只是增加了對成本，我們不應該允許的話，”他說。