CASHLESS MEDICLAIM ROW
Policy holders fleeced, made to pay more …….Risha Chitlangia
Hospitals Charge Much Less For Govt Scheme
Policy holders fleeced, made to pay more …….Risha Chitlangia
Hospitals Charge Much Less For Govt Scheme
In the battle between health insurance companies and hospitals, policy holders are the biggest casualty. Insurance companies claim that they have withdrawn the cashless facility from highend hospitals to standardize the cost of healthcare and make it affordable.
Though corporate hospitals deny the allegation of overcharging, third party administrators (TPAs) say patients are often subjected to unnecessary diagnostic tests to inflate the bills. Javed Akhtar (28), who was recently admitted to a private hospital, agrees. Last month, Akhtar, who works with a private firm in Noida, had a minor accident and was admitted at a city hospital. He gave his cashless policy number to the hospital for TPA approval. But, he found that the hospital had applied for a spinal surgery and had got Rs 80,000 cleared. I was not even told about the surgery. They took the approval by forging my signature, said Akhtar, who refused to get operated and got a police complaint registered. But as he didnt get operated, the TPA refused to clear the bill.
TPAs say patients are often subjected to unnecessary tests to inflate the bill. As a result, only a few insurance claims actually get settled. Hospitals often get unrelated tests done. More than three consultants visit the patients twice. The most expensive room is offered to policy holders for which they have to pay from their own pocket, said an official. In most hospitals the consultants visit charges are linked to the room rent. Higher the room rent, more the visiting charges. In some hospitals, the cost of diagnostic tests also varies with room rent.
But hospitals say patients require tests by a multi-disciplinary team of doctors. We cant deny him the care because the policy doesnt allow it. If TPAs feel that certain hospitals are overcharging, they should select hospitals clearly. The recent move by insurance firms has caused acute discomfort to the patient, said Dr Sanjeev Bagai, CEO, Batra Hospital.
Interestingly, a private hospital gives the same facility at two prices to different patients. For example, it has lower rates for patients who come through the Central Government Health Scheme (CGHS), which provides healthcare to central government employees and their family. A bypass surgery, as per CGHS rates, would cost Rs 1,30,000, but the same surgery would cost a policy holder close to Rs 4 lakh, said a government doctor.
But hospitals are defiant and have decided to take it up with CII. This will affect not only the hospital but patients too. We have to see our interest also. As for CGHS, we provide our services in only three categories: cardiac, renal transplant and joint replacement, said Sunil Kapur of Fortis Healthcare.
How hospitals overcharge
How hospitals overcharge
* High-cost rooms
* Charges for consultant visits as per room rent
* Cost of diagnostic tests also depends on room rent
* Patients forced to undergo too many diagnostic tests
* A multi-disciplinary team of doctors sees the patient even if she/he doesnt require the services
* Cost of consumables used in surgery often very expensive
* Increased hospital stay
