Lost in the System: When Digital Promises Fail Common Man

DR. ASOKE K. LAHA
Chairman-Emeritus and Founder, InterraIT

A friend of mine started his journey from the suburb of Delhi to a popular place close to the central Delhi in connection with direction he was given by a Third-Party Administrator, popularly known as TPA, of an insurance company. He recently had undergone cataract operations in both his eyes in a well -known hospital specializing in ophthalmology. He and his family have an insurance cover, which he has taken almost three decades ago. The cashless system enables him and his insured family members to underwrite all expenses incurred towards medical treatments with a few exemptions which are not significant.

Also, the patient must be hospitalized. The hospital where the cataract surgery was done, does not have any overnight hospitalization facilities. Since hospitalization is a necessary condition for the insurance coverage, what this hospital does is to admit the patient a few hours ago before the surgery and let him undergo the operation, then keep the patient for an hour or so under observation if the patient has any previous complications.

There are two types of expenses involved for a cataract operation. The first one is the expenses towards surgery, which is levied beforehand. In a hospital where there are usual beds to keep the patients under watch for days together, every expense must be settled by the hospital directly with the insurance company with the intermediation of the TPA. Since this hospital does not have that facility,  the  expenses  incurred are collected in two ways. The insurance company will have to undertake payment of the expenses depending on the cost estimates sent by the hospital. Normally, the insurance company cuts down the estimates going by the argument that the cost has been inflated and above the standard rates fixed by the insurance company for such surgeries. For the post–operative care in the hospital, the patient will have to send the bills including medicines and follow up tests directly to the TPA to get the reimbursement.

For the post-operative care, invariably the TPA will raise some queries about the bills. In his case, the same thing had happened. The TPA had sent him a message in his smart phone to explain about the queries that were raised. He must visit the nearest office of the TPA in five days’ time. His ordeal started from there. Since there was no specific address given in the advisory, my friend tried to check with the nearest office of the TPA from the Google. It showed a non-descript place in Karol Bag, a bustling business hub in Central Delhi. He specifically told the car rental company, from where he hires the car regularly to send a driver who knew the logistics of that crowded place which is known for its narrow and crowded roads.

He boarded the car in the nick of the time. Since it was morning hours of a typical Friday, roads were crowded. From his place in the Southwest Delhi to Karol Bagh, the taxi took almost an hour.

The ordeal started since then. The GPS has been giving wrong directions  so  also the people whom the driver asked for way to the office of the TPA. At least an hour or so has been spent in identifying the exact position of the office of the TPA. He started suspecting efficacy of the GPS: how it can fail in giving the landmark of a place and that too the office address of an important TPA attached to a government run general insurance company.

He was at the wits end, while going around without reaching the destination after an hour or so. As a last-ditch effort, he alighted from the car and asked the driver to follow him. He asked a few people whether they knew this place. Most of the people said they did not know the place. He asked a rickshaw puller nearby whether he knew the place. The rickshaw puller told him to board his rickety rickshaw and ride with him. He told the driver to park the car somewhere and to wait for his call once  work  was done the rickshaw puller peddled for a few minutes and brought him to a dingy place where a string of dilapidated offices is there. The rickshaw puller asked him to alight at a specific point. The address matched with the coordinates given by the Google. But there was no board neither at the appointed office nor at the adjoining shops. To cut the long story short, his mission was an utter failure and the address given in the Google was wrong.

His ordeal will be incomplete if I do not mention the rest of the story. Upon struck in a limbo about the address of the TPA’s Delhi office, he tried to connect with the TPA’s main office in Chennai and requested them to message the correct office address. They picked up the phone and told him to come in the chat mode. While he sent the message asking for the address, the person chatting stopped that also. Then he tried to call up the office, the same number, which responded initially. Despite his repeated efforts, he could not connect with the office.

My friend told me a few things which I thought I should narrate here. The foremost thing is the Google address and wrong pathways indicated by the GPS. I discount for the GPS direction partly because in his anxiety to find the place, he  might  have lost his wits and would not have given due attention to the guidance of the GPS. The taxi driver perhaps might not be experienced in tracking Google directions.

Yet, what I am aghast is why Google is giving a wrong address, which I checked myself. Does it mean that proper up-dation is not taking place at Google’s end or at the company’s part. Is there any mechanism to update the addresses on a continuous basis?

Digitization is an ongoing exercise and all encompassing. Our effort should be to bring people of all hues to the mainstream and should  not give a  feel that it caters to only a select segment of the society. That needs a lot to be done to reach out to every segment of the citizenry. The bottom line is to make digital operations user friendly and fault free. Can we do that?