Interview: Sumit Gaurav, Roy Medical Assistance
Sumit Gaurav, CEO of Roy Medical Assistance, shared details about the company’s development and recent activity
What is your background in the international healthcare industry, and what advantage does your professional background give in in the medical assistance world?
While working within the international healthcare industry in the past, I was aware that most international insurance policyholders were facing difficulties in finding the appropriate medical services, as most hospitals denied cashless treatment due to major leading insurance companies either stopping or delaying payment. Many insurance companies were not responding to communication attempts. I thought, this is the right time; service providers need an international TPA company to facilitate and coordinate with patients, insurance companies and the hospitals themselves as well. Hence, Roy Medical Assistance (RMA) was founded in 2016 as an international TPA to fulfil the needs of customers by providing a 24/7/365 alarm centre. Our efficient team managed to build a huge network by entering into agreements with many of the leading hospitals in Asia to provide assistance services to tourists, expats, students, diplomats and any other international visitor in need of help. Our team personally visits providers across Asia to build a relationship with service providers and insurance companies, and acts according to the agreements we make with them. RMA has been working in this industry for more than six years, and our claims settlement ratio to the hospitals is 99 per cent. As of now, RMA works with over 5,000 hospitals in 16 countries such as India, Nepal, China, Hong Kong, Vietnam, Indonesia, Thailand, Singapore, Cambodia, Maldives, the UAE, Turkey, Sri Lanka, Philippines, Myanmar and Azerbaijan, with direct billing agreements in place that allow hospitals to provide cashless outpatient and inpatient treatment.
What inspired you to start RMA?
Before 2016, I saw many international patients facing the problem of obtaining cashless treatment in hospitals, and many hospitals in Asia and Middle East were under a high volume of debt. Hospital management was not structured nor willing to accept guarantee of payment documents from insurers in foreign countries. We discussed this issue with hospital management teams and we assured them that we will coordinate the claims settlement process, acting as a local guarantor with a local office. After many years of waiting, they agreed – albeit with a lot terms and conditions attached.
What can international insurance companies gain from working with RMA?
As the local guarantor, most hospitals in our network accept our direct billing agreement, which provides insured clients with a great many benefits: • Access to a hospital within a two to five-km radius of the patient: As we know, all patients want a good hospital with the best facilities near their home, work place or hotel. • From one company, international insurance companies can be connected with over 5,000 hospitals in 16 countries. We have our own medical team in our assistance centre who help the patient, and issue the medical reports in such a way that the international insurance company will understand the treatment protocol and charges in order to approve any further treatment without delay. We have our own claims and payment team who can verify the benefits and pay the provider without waiting for a guarantee from the insurance company. We provide all the necessary support and logistical services to our international insurance company partners. Whenever clients need medical assistance in remote areas, we offer an instant payment transfer method, so that the insured client enjoys cashless benefits. RMA ensures customer satisfaction, working closely with hospitals, and our representatives communicate frequently with the patient to provide them with all the support they need.
What are the biggest challenges you have faced when setting up your medical network in Asia, and how do these challenges differ in the various countries?
We faced many problems setting up medical network in Asia, not least of which was that when we first talked to hospitals over the phone, it was the first time they had heard about RMA. Understandably, hospitals did not initially agree with our terms and conditions. Our team had to travel to countries to meet with hospital management staff and introduce the RMA team. After continuous follow up with hospital management teams regarding direct billing agreements, and after they had ensured due diligence checks on RMA by finding information about us from other hospitals and clinics already in our network, they agreed with our terms and conditions. The process took about two to three years. We have found that in certain countries – Singapore, Thailand, Vietnam, China, and the UAE – hospital management prefers working with a local office in their own countries to ensure smooth patient coordination and in terms of payment, as they are not in favour of extending credit facilities to international insurance and assistance companies outside Asia.
Are there any uniquely challenging cases you’ve handled recently that exemplify your company’s service offerings and talents?
Recently, we got a call from the Maldives (Thulusdhoo Island) at 1 a.m. The case involved a tourist from Colombia who had suffered a brain haemorrhage at 12.30 a.m. Thulusdhoo is very small island; there are two or three hotels, and nothing else. We contacted with the local doctor and sent him to the island by speed boat at 2 a.m. local time. They provided initial treatment and waited for the transfer to Male, which is 200 km away from this island by speed boat. Early morning came and we sent a sea plane to Thulusdhoo Island with our medical team onboard and evacuated the patient to our network hospital in Male. After two days, the patient was referred to a higher level of care in India. We organised an ICU air ambulance with ventilator support to transfer the patient to New Delhi, India. After 20 days she recovered and was discharged from the hospital. She still, however, needed to get back home to Colombia and we arranged her ticket and all the necessary medical support, including a medical escort for the 26-hour journey. The patient reached her home country comfortably, and the mission was a success.