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QUESTIONNAIRE

1. From which company have you purchased your current health insurance policy? Public Sector Company (National, Oriental, New India, United) Private Sector Company

2. Which of the following was the most prominent reason for which you to bought a health insurance?

Anticipation of need Hardcore telesales

Out of the compulsion of Job Because of poor health / recent poor health of Self / Family member

3. While comparing health insurance policies of different companies, you gave importance to the aspects related to Health Insurance Policy Health Insurance Company

Third Party Administrator (TPA)

All of the above

4. What do you think is the role of TPA in health insurance?

To facilitate cashless treatment among a network of hospital covering wider area.

To provide reimbursement of the costs paid to acquire health care.

An intermediary between customer and the insurer to facilitate easy settlement process.

To keep record of customer’s health, facilities availed and costs paid.

5. Did you know about the procedure of cashless treatment / reimbursement through your health insurance policy?

Yes

No

6. Did you face any problem while availing the cashless treatment?

Yes

No

7. In which of the following area related to cashless settlement did you face the problem

Planned cashless treatment Emergency cashless treatment

8. What was the problem you faced? Delay in response of TPA Reimbursement

Reimbursement of treatment expenditure Reimbursement of pre/post treatment expenditure

Overcharging Any Other (Please Specify)

9. How long it took your TPA in approving the pre-authorization form?

Less than 4 hours (Very Efficient) 8 to 12 hours (Average) More than a day (Very Poor)

4 to 8 hours (Efficient) Less than a day (Poor)

10. Was there any difference between the estimate provided to you as an individual and estimate

provided for cashless treatment, if Yes, Kindly tell us the most appropriate range which measures the difference:

No Difference More than 50%

Less than 50 % More than 100%

11. Do you think that existence of TPA has improved the overall system of health care through health insurance?

Yes

No

12. Do you think that existence of TPA has increased the cost of health care and health insurance? If yes, kindly answer next question, otherwise skip next.

Yes

No

13. What do you think is the most prominent reason for increased cost of health care through health insurance at hospitals?

Additional costs on part of hospitals

Additional costs on part of TPA

Additional costs on part of both hospital and TPA

Margin for error and additional cost is kept at the time estimate for pre-authorization

Connivance of both hospital and TPA to charge more

14. Did your TPA provide you with the literature or instructions on settlement process and other aspects?

Yes

No

15. Please indicate the extent to which you are satisfied or dissatisfied with the overall service provided by the current health insurance policy. (Kindly tick (√) the proper box). Very Satisfied Satisfied Indifferent Dissatisfied Very Dissatisfied

16. Please indicate the extent to which you are satisfied or dissatisfied with the overall service provided by the TPA through your health insurance policy. (Kindly tick (√) the proper box). Very Satisfied Satisfied Indifferent Dissatisfied Very Dissatisfied

17. Are you so happy with the services of your TPA/company that you will renew your policy with the same insurer?

Yes

Probably yes

May or may not be

Probably no

No

18. Please indicate the quality of service provided to you by TPA on the basis of following parameters on a scale of 1-5.

5

- Extremely good

4 – Good

 

3 - Neither Good nor Bad

2

– Bad

1 - Extremely Bad

Sl.No.

Factors

Score

i.

Sensitiveness

1111

2222

3333

4444

5555

ii.

Promptness

1111

2222

3333

4444

5555

iii.

Helpful

1111

2222

3333

4444

5555

iv.

Paper formalities

1111

2222

3333

4444

5555

v.

Processing of pre-authorization

1111

2222

3333

4444

5555

vi.

Admission of patient

1111

2222

3333

4444

5555

vii.

Accessibility

1111

2222

3333

4444

5555

viii.

Increasing cost

1111

2222

3333

4444

5555

ix.

Convenient operating hours

1111

2222

3333

4444

5555

x.

24x7 Customer care

1111

2222

3333

4444

5555

xi.

Settlement of bills

1111

2222

3333

4444

5555

xii.

Complaint redressal

1111

2222

3333

4444

5555

xiii.

Trained Staff

1111

2222

3333

4444

5555

xiv.

Accuracy in keeping records

1111

2222

3333

4444

5555

19. If your friend wishes to buy a health insurance policy, would you be willing to recommend the same policy considering the services of TPA?

Definitely yes

Probably yes

May or may not

Probably not

Definitely not

20. Please indicate the extent to which you agree or disagree with the following statements. (Kindly tick (√) the proper box).

Strongly

Agree

Indifferent

Disagree

Strongly

Agree

Disagree

Helpdesks(Point of Interaction) My TPA was easily accessible at the help desk

of

hospital.

TPA’s Helpdesks are efficient and prompt and

I

felt that getting serviced through a TPA is a

ease the process of coverage / admission / Discharge. Information given by TPA Helpdesk for various

purposes was clearly understandable. There should be a system of immediate

feedback on service of a TPA at Helpdesk.

complex process.

No grievance redressal mechanism is there in

place at helpdesk for health insurance customers. Helplines of TPAs/insurance companies are mere an eyewash

Information Information given by TPAs through its leaflets / consumer guide is clearly understandable.

faced difficulty in getting information about the process of admission, discharge and

I

settlement

I

was unable to understand the terms and

conditions of my health insurance policy

My TPA was helpful in providing information

to

me regarding my health insurance policy

Service TPA was prompt in replying on pre-

authorisation while I got my patient / myself admitted in hospital TPAs refused the coverage partially / fully.

Agents / telesales / helplines are more keen in selling their insurance than understanding my

needs and helping or providing information

Overall

Health insurance would have been simple

without TPAs. Cost of treatment would have been

substantially less than what I paid through TPA based health insurance. Government needs to introduce stricter norms

to

control TPAs.

I

would like request the company to change my

TPA. TPAs should be removed from the business of health insurance.

21. Please indicate the quality of service provided to you by TPA Employee on the basis of following parameters on a scale of 1-5.

5 - Extremely good 4 – Good

2

– Bad

1 - Extremely Bad

3 - Neither Good nor Bad

Sl.No.

Factors

Score

i.

Understanding of your need

1111

2222

3333

4444

5555

ii.

Personal/individual attention

1111

2222

3333

4444

5555

iii.

Knowledge and answering of queries

1111

2222

3333

4444

5555

iv.

Ease of contact

1111

2222

3333

4444

5555

v.

Politeness

1111

2222

3333

4444

5555

vi.

Trustworthiness

1111

2222

3333

4444

5555

vii.

Availability

1111

2222

3333

4444

5555

viii.

Willingness

1111

2222

3333

4444

5555

ix.

Problem solving

1111

2222

3333

4444

5555

x.

Sincerity

1111

2222

3333

4444

5555

xi.

Correctness of information

1111

2222

3333

4444

5555

xii.

Correctness of service

1111

2222

3333

4444

5555

xiii.

Waiting time

1111

2222

3333

4444

5555

xiv.

Maintenance of office

1111

2222

3333

4444

5555

xv.

Maintenance of equipments

1111

2222

3333

4444

5555

22. Please tell us about yourself -

Age group (years)

Less than 18

18 – 25

26 – 45

≥ 45

Education Level

Under graduate

Graduate

Postgraduate

Others

Occupation

Service (Govt.)

Service (Pvt.)

Professional/Business

Others

Monthly Income

≤ 20,000

20,000-40,000

40,000-60,000

≥ 60,000

Name, Add., & Ph.No.

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