Disclose agreements between TPA and hospitals’

 

The agreements between public sector health insurance companies and hospitals, including
those with third party administrators, should be disclosed to ensure transparency in delivery of
medical services to an insured person, Central Information Commission has held.
The Commission rejected the arguments put forth by Oriental Insurance Company that the
agreements are between the Third Party Administrators (TPA), to whom the processing of
claims is outsourced by the insurance companies, and the hospitals and since the TPAs are not
public authority, there is no obligation to disclose these agreements.
Information Commissioner Deepak Sandhu held that funds for implementation of health
insurance policies is paid by the respondent (Oriental Insurance) which is collected as premium
from its customers.
“Therefore this argument is without merit,” she said directing the company to disclose the
information. However, the Information Commissioner agreed that some portions of these
agreements could be severed as it could adversely affect commercial interests of the company.
Sandhu was hearing the plea of an RTI applicant who had sought information from Oriental
Insurance on the issue and list of hospitals across the country which provide cashless
treatments facilities.
“The disclosed portions would serve to provide greater transparency in respect of the medical
services to which the insured are entitled and therefore lend itself to better service been
provided to the insured,” Sandhu held in her order and also directed the company to place on
its web site the names of hospitals which provide cashless treatments.

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