GURUGRAM: Out-of-pocket expenses have been high for families of Covid patients who were or are still being treated at private hospitals in the city, not just due to hospitalisation costs that their policies don’t cover but also lack of clarity about differential rates.
Frequent spats over how patients are billed has led to some states, including Haryana, setting up committees to study complaints of excess billing.
In Gurugram, 15 such complaints have so far come to the panel.
But once informed about the rules by hospitals, many have just accepted the bills, which have made big dents in their savings accounts or forced them to take loans at steep interest rates.
“We are looking into each case carefully to see if the patient was overcharged by the hospital.
We have to evaluate on a case-by-case basis as the hospital bill is generated on the basis of an individual’s mediclaim,”said Dr Virender Yadav, chief medical officer, Gurugram.
Insurance and hospital officials told TOI arguments over bills mostly originated from a misunderstanding of treatment rates.
Patients’ families have been citing the government cap on Covid treatment rates to contest the bills, unaware that for insured patients, these caps don’t apply.
The financial blow has been palpably bigger for critical patients who have needed ICU or ventilator support.
On an average, said insurance officials this correspondent spoke to, a 7-10-day stay at a private hospital in the city for such patients runs up a bill of around Rs 10 lakh (with comorbidities or other complications, the bill could be higher), while the average settlement has been Rs 5-6 lakh because policies have maxed out.
Based on the VK Paul committee’s recommendations, the Haryana government had on March 23 last year set caps on the cost of Covid treatment at hospitals in the state.
The order by additional chief secretary (health) Rajeev Arora also specified that for fully insured patients, hospitals can charge insurance policy rates.
According to this cap, daily charges are capped at Rs 10,000 for Covid wards, Rs 15,000 for intensive care and Rs 18,000 for ICU with ventilator support.
For patients with insurance, hospitals in the city charge different rates, based on the policy.
For Covid wards, this can be up to Rs 20,000 a day, Rs 60,000 for intensive care and Rs 80,000 for ICU with ventilator support.
This doesn’t include doctor consultation charges, charges for various procedures that may have to be performed and the cost of additional medicines a patient may require.
Asked about the billing process, an official in the finance department of a leading private hospital explained, “We begin with asking if the patient is covered under insurance or not.
If the patient has a medical insurance policy, then we ask for the details for the policy and on the basis of that, we charge the patient.
Every policy provides a different rate for per day hospitalisation charges.
We have to prepare a bill accordingly.
Only those who don’t have insurance cover are being charged according to the Haryana government prescribed rates.” An official at another leading private hospital confirmed this.
“The rate varies for each policy, and thus we charge differently from patient to patient.
There cannot be uniform charges for insured patients as each policy and its rate varies.” A 39-year-old resident of Sector 65 tested positive for Covid on May 9 and was admitted to a private hospital.
His mother Charu said after 20 days, the bill came to around Rs 11 lakh.
“We informed the hospital the patient had a mediclaim of Rs 8 lakh and the insurance firm was processing the documents.
But the hospital said the bill would be revised to Rs 15 lakh since the treatment cost cap does not apply to insured patients,” said Charu.
Karnal resident Ram Kathuria (66) found himself in a similar situation when his son was hospitalised after testing positive for Covid on May 25.
His son spent two days in ICU and needed oxygen support.
The retired schoolteacher claimed the bill amounted to Rs 2.5 lakh, including blood test and remdesivir charges, which caught him off guard because his own calculation was based on the government rates.
“It wasn’t fair.
I was never told clearly that if I apply through my mediclaim, the charges will be different.
I filed a complaint with the health department on June 1.
I had to spend all my savings,” said Kathuria, who took out a loan on his credit card.
Kathuria had insurance, but he claimed it wasn’t covering most of the costs.
Aman Singh (46), who works as a fashion designer with a clothing retail chain, said the hospital bill for his wife’s Covid treatment came to Rs 10.5 lakh, but her insurance coverage was only Rs 5 lakh.
“It got exhausted and we had to spend from our own pocket to pay the remaining bill.
We have not raised any complaints as we should have got a bigger cover.
I am just happy she is back from hospital and doing well,” said Singh.
Officials with medical insurance companies said they had been settling claims in line with the insured amounts in a policy.
Anurag Rastogi, president – chief actuary & chief underwriting officer, at HDFC ERGO General Insurance, told TOI, “The industry average of mediclaims settled for Covid-19 hospitalisation sums up to approximately Rs 96,000.
At HDFC ERGO, the average per day amount settled for Covid-19 hospitalisation stands at Rs 1,28,000, which is higher than the industry standard.” Bhaskar Nerurkar, head – health claims, Bajaj Allianz General Insurance, said, pegged the industry average at a higher Rs 1.2-1.4 lakh.
“Covid-19 claims are being paid on a cashless or reimbursement basis like other health insurance claims.
It is recommended for customers to understand their insurance contract and the coverage provided.
This will give customers better insight to review their bills and understand the overheads charged as precaution.
Insurance companies are also paying for equipment charges like PPE kits, masks and gloves, among other things,” he said.
Asked about the excess billing complaints, ACS Arora told TOI, “We have set up a three-member committee at each district to carefully address the hospital bill claims and the complaints associated with those.
Private hospitals are directed to charge rates fixed by the government of Haryana for Covid patients.
Patients who have health insurance policies are to be changed as per their policy rate by the hospitals.
We cannot have a fixed rate for insured patients as each policy is different.”