Hyd COVID-19 patient forced to stay in hospital as insurer and hospital spar over bill

The Hyderabad COVID-19 patient had been charged over Rs 4 lakh for treatment at a private hospital. His insurance company, however, only approved the claim for Rs 1.2 lakh.
Hyd COVID-19 patient forced to stay in hospital as insurer and hospital spar over bill
Hyd COVID-19 patient forced to stay in hospital as insurer and hospital spar over bill
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Even four days after recovering completely from COVID-19, Manoj Kothari, a 47-year-old patient, has been forced to stay in Hyderabad’s Yashoda Hospital. He alleges that the private hospital has refused to discharge him because of a dispute with his insurance company regarding the treatment costs. 

Manoj was charged Rs 4.21 lakh for the treatment but his insurance company, United India Insurance, approved the claim for only Rs 1.20 lakh. The insurance company claimed it had cleared the amount, as per its calculations based on the Telangana Government’s Order which fixed the price for the treatment of COVID-19.   

He  was admitted to Yashoda Hospital in Somajiguda on June 20 and was considered fit for discharge on June 29 after his recovery. A worried Manoj who remains confined to his room, alleges, “From Monday, I am not being allowed by Yashoda Hospital to meet or talk to anyone. I am being tortured and I am not being given any treatment since then. If something happens to my life, who will take the responsibility?” 

Manoj says that he was informed that he would be discharged from the hospital once the difference was paid. 

A representative of Yashoda Hospital told TNM, “State govt GO is for general/cash paying patients. Not for patients who have some coverage(ex CGHS /ECHS/insurance) they (insurance companies) are supposed to approve/pay as per the agreed tariff/mou guidelines.” The hospital representative put the onus on the patient saying that he should have paid the difference and left, and later claimed the amount from the insurance company. TNM tried reaching out to the representatives of United Insurance India, but our calls went answered.

Yashoda Hospital raised the matter of the claim in a letter to the medical officer of the insurance company. “The circular issued by the government is intended for self-paying patients and not for insurance cases. Insurance services and approval should be on the basis of scope of service provided as per their policy terms. Hence, we urge you to approve the bill as per the policy and favour the patient,” it wrote. 

By the way of Manoj’s insurance policy, his sum insured is Rs 5 lakh, which would cover a room rent of Rs 5000 a day (Non ICU). However, given that he has a limit of as high as Rs 5 lakh, it is unclear why the insurance company has only approved an amount of Rs 1.2 lakh out of the total treatment cost of Rs 4.21 lakh.

In some instances, hospitals have also been charging exorbitant amounts under consumables (PPE Kit, masks, etc), which are not covered under any insurance policy. 

TNM tried reaching out to United Insurance CMD Girish Radhakrishnan, all calls went unanswered.

In GO 248, the Telangana government has fixed the treatment in ICU at Rs 9,000 per day. This also includes charges for ventilator, medicines, consultations, meals and catheterisation and few more similar services. However, it does not include high-end investigation tests, PPE kit charges and few other complex procedures. The charges for ICU without ventilator has been capped at Rs 7500 per day and for general ward has been capped at Rs 4000 per day. 

Meanwhile, two other members of Manoj’s family also tested positive for the coronavirus and are presently under treatment in the same hospital. He fears they will also end up facing the same issue. Requesting the government to take a firm stand on the issue, Manoj says, “I request CM KCR, KTR and also the Health Minister to do something about this injustice being meted out to patients by corporate hospitals.”

Speaking to TNM, Dr Sanjeev Singh Yadav, Secretary, Indian Medical Association (IMA) Telangana says, “It is wrong to hold the patient responsible for the dispute between the insurance company and the hospital. If he had recovered, the patient should have been discharged and the hospital should have taken up the issue with the insurance company.” When asked if the government is doing enough to avoid such situations, Dr Yadav says, “The Telangana government’s decision to cap prices of the treatment procedures is an appreciable move, but the reality is that there is no regulating body to ensure execution of the same.” 

The prices fixed by the Telangana government are less than half the price that the corporate hospitals usually charge and this has caused enough worry for the corporate hospitals, while giving insurance companies a scope to pay less. As there is no clarity about whether the GO is applicable only to self-paying patients, this looming ambiguity has resulted in patients ending up at the receiving end.

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