Medi Assist is India's leading Third Party Administrator delivering capabilities to the insurance ecosystem across geographies and networks for over two decades.

If you're working in a corporate in India, and if your employer is providing you medical coverage or a health insurance as part of your employment benefits, most likely you will have a TPA

😅 Medi Assist serves one in every two corporate individuals with a health insurance plan, leveraging cutting-edge technology to drive measurable outcomes and ensure seamless experiences for its diverse stakeholders. With a focus on user-friendly platforms and a robust network, Medi Assist continues to redefine the standards of healthcare administration, empowering its clients and partners with its expertise and resources.

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XCO is an experience product backed by technology, meant to
(i)Customer Solution - provide certainty to patients for their hospital exit in case of a cashless discharge
(ii) Enterprise Solution - to help hospitals vacate a bed as soon as possible, enable them to admit the next patient in queue. (improving their NPS and operational excellence parameters, increase revenue with faster bed churn rate)
(iii) TPA - benefits from reduced interactions with claimants, therefore, reducing the cost and experience parameters.

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The transaction for cashless today causes so much dissonance in the mind of its policy holders, since the claim processing is post facto (post the hospital treatment - prior to exit)

(i) removes hassles for consumers who have to wait for their CL discharge
(ii) it reduces anxiety for the caregivers, as they can take the patient home ASAP
(iii) it marginally reduces the cost, for the patients who otherwise have to extend their stay due to delays in approval.

(i) delivers certainty to both patient and caregivers for a hospital exit in cashless discharge.
(ii) eliminates dissonance from the minds of the insurance policy holders
(iii) saves them time and provides convenience

(i) the entire CL discharge experience for insurers and TPAs is broken.
(ii) for some patients it can take 30 mins for CL approval to come, for others it can take 6 to 8 hours and for a few it may take upto the next day for the insurance approval.
(iii) But the question, every patient or caregiver discomfort “How long will it take them to exit the hospital?”

Patients resort to :
(i) continuously pressurising the TPA desk executive in the hospital or making multiple calls to the Insurers / TPA - customer support team to fastrack claim process.
(ii) Where possible, patients also reach out to their insurance agents, brokers, account managers, HRs to request favours for an early discharge.
(iii) in some cases, the patients resort to making the entire payment in CASH, and claiming reimbursement later on.

Claim processing TAT is a dissonance which is post facto. The health insurance industry today perceives this as a radical arduous problem, that given, every key player in the ecosystem is solving this by reducing the TAT incrementally. How so? By deploying more operations and people bandwidth to expedite discharges in hospital. In my opinion, the promising experience is a lip service and not really a solution that the category is emphasising on. Delay in cashless transaction is a post facto perception. (not the entry perception) To simply put, there is no innovation brought by the insurance givers.

For example, think about it, if you’ve ever availed your health insurance:​

Making the right decision when purchasing an health policy in itself a tedious and confusing place.

Agents, brokers have done their job → INSURANCE SOLD ✅

Now when comes time to avail the benefits of your health plan, there is SOLD a promising assistance end to end.

Yet, why do we all come across escalations on social channels and have a pre-notion that CLAIMING INSURANCE IS DIFFICULT?

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Once the treating doctor advises discharge, hospitals get to their jobs of collating the bills and sending it to TPA or insurance.

Hospitals’ job done ✅

Enters, TPA or third party administrators who service policy holders through claim adjudication on behalf of the insurance company.

Their job is to adjudicate the claim fairly, and the time to do this job, is uncertain. ⌛️

(As it varies, case to case based on insurance policy benefits, patients health history and hospitals’ treatment undergone.)

Now, whatever kind of patient/caregiver, i.e. a first time experiencer, the frequent claimant, or the one with an anticipation that it would be smooth - faces uncertainty and inconvenience of how long will they have to wait after doctor has advised discharge?

The answer is simple, until the claim is processed, and hospital is informed that insurance will back the patients hospitals bill, this is where TPA/Insurance job is done ✅

How is the experience of the waiting period for the patient/caregiver ⁉️

Uncertainty leading to being Anxious, Distressed, Surprised, questioning themselves, “DID I PAY A PREMIUM AND BUY A HEALTH INSURANCE FOR SUCH AN EXPERIENCE?”

Who solves this problem for the patient/caregiver (aka policy holders)?

🏃🏽 Xpress Checkout

Like I mentioned before, Xpress Checkout is a category creator in this space. Traditionally users solve this problem by
a. pressurizing the TPA executives at hospital desks or calling their customer support agents
b. requesting favours from their brokers, insurance companies, or relationship managers c. upon not receiving a solution in the moment, they opt out of cashless and claim for reimbursement later on from their insurers.

On speaking to several such users, it was evident they expressed uncertainty in the discharge TAT, regardless of resorting their approaches. All they looked for was an answer, on “how will I have to wait to exit the hospital after discharge?”

Clarity, Transparency and Guidance
Users may encounter challenges due to a lack of clear communication and guidance throughout the claims process, leading to confusion, dissatisfaction, and potential delays in claim settlements
They want to transition from hospital to home without unnecessary complications.

Given they are well informed about their claim status, they can wait, pay out-of-pocket expenses, if any.

To be understood and treated FAIRLY.
The don’t want their health benefits to feel very transactional.