In September this year, Ajay*, a 46-year-old resident of Bengaluru, who previously worked as an office boy at a private company, tested positive for the coronavirus. Having difficulty in breathing, he approached a private hospital in Shivajinagar for a bed. The hospital allegedly told him that as there was a shortage of COVID-19 beds in Bengaluru, he would be charged Rs 30,000 per day for an oxygen bed - over double the amount fixed by the state government for a High Dependency Unit.
In a government order dated June 23, the Karnataka government fixed tariffs for the treatment of COVID-19 patients in private hospitals. The state set a package rate ceiling for COVID-19 patients referred by public health authorities to private hospitals. According to the June notification, private hospitals can charge Rs 5,200 per day for a general bed, Rs 7,000 for a High Dependency Unit (HDU), Rs 8,500 for an ICU bed and Rs 10,000 for a ventilator bed. This price applies to those who are referred by the government and the money is paid by the Suvarna Arogya Suraksha Trust and not the patients themselves.
The state also capped tariffs for those like Ajay approaching private hospitals on their own and paying in cash. While a general ward is Rs 10,000 per day, a HDU is fixed at Rs 12,000, ICU without a ventilator at Rs 15,000 and ICU with a ventilator at Rs 25,000 per day. The package rate includes PPEs and food.
When asked whether he knew about the price caps set for private hospitals, he said, “Yes, we knew. What could we have done? Everywhere on the news they are saying no beds. If I had let this one go, I didn’t know if I would get treatment.”
Ajay’s wife sold two gold bangles for Rs 70,000 and used the cash to pay for his admission at the hospital. The total bill for Ajay’s eight days in hospital amounted to Rs 2.4 lakh. The couple had no option but to borrow from a money lender to pay the bill since he had no insurance.
“I don’t know how to repay the loan. The government is helping private hospitals and not poor people like us,” he said, while adding, “My wife sold the last of her jewellery. We are now struggling for two meals. I have been looking for a job but no one is hiring me,” said Ajay, who was laid off from his job before he was diagnosed with COVID-19. Ajay has now contacted the Suvarna Arogya Surkasha Trust (SAST), a government insurance trust for treating COVID-19, to get a refund. “I hope I get the money back. If I do, then I can repay the loan,” he added.
Most patients or their families are unaware of the nitty-gritties about the types of beds allocated to them. Officials with the SAST said that the problem could be in the lack of awareness. “The awareness posters in public places and all hospitals only say that the cost is free if patients are referred by the government. There is no information about how the process works. Most people are also scared of delays in allocation of beds if they have to rely on BBMP (Bruhat Bangalore Mahanagara Palike) and so they approach private hospitals directly,” the official said.
The SAST in Bengaluru has a call centre with eight persons in each zone, dedicated to make calls to each COVID-19 patient admitted to a private hospital in their respective zones and finding out whether they were charged more than required. In cases where patients were charged more, the extra money is refunded to the said patients and this amount is deducted from the total amount that would be reimbursed to the hospital. SAST officials told TNM that even patients referred under government quota were charged Rs 3-7 lakhs for treatment for an average of 6 to 9 days and that the hospitals also filed claims with the SAST.
Since August this year, the SAST has made 12,000 calls to patients who were admitted in private hospitals, of which around 7,000 picked up the calls. Of these, 300 furnished documents which showed that private hospitals had charged them more than the price cap that was set. SAST says that on an average, they get 6,000 claims every day from private hospitals for treating patients under the government quota and their task is to vet each one of them. “In most cases, people don’t pick up the calls at all and we have to keep calling them. After a point we also stop as there are so many claims to look at,” the official said.
SAST conducted inspections on 100 private hospitals empanelled for COVID-19 and found that 44 of them were overcharging patients. “It's the greed of the private hospitals that never abates. People should also start becoming more aware but when it comes to private hospitals, they are just using the people’s distress and panic to their benefit,” a senior official at SAST said.
The desperation to get a bed at a hospital has left many COVID-19 patients at the mercy of private facilities. Besides overcharging, a number of private hospitals are cashing in on the desperation of COVID-19 patients and their families by forcing them to take beds that do not come under the price ceiling.
Last week, Sowmya*, an 81-year-old Bengaluru woman, who tested positive for the coronavirus and was diagnosed with pneumonia, was allegedly told by a private hospital in Kumaraswamy Layout, that she could get admitted. They informed her that the cost per day for a ward would be Rs 35,000 for the first night and Rs 25,000 each for the subsequent days she would be at the hospital. The woman, who has a shared insurance with her husband, was unable to use it as the claim limit had been reached due to multiple procedures he underwent earlier this year.
Her family, which was unable to pay such an exorbitant amount, desperately began looking for another hospital bed. Finally, the 81-year-old woman and her daughter, who also tested positive, were admitted to a twin-sharing suite at another private hospital in the city. However, they were asked to deposit Rs 1 lakh each and were charged Rs 25,000 each for the twin-sharing suite. The amount, their family says, covers food and the beds.
“The hospital in Whitefield is more reliable compared to the one in Kumaraswamy Layout and my aunt knows people there, so we were more comfortable going to that hospital,” Sowmya’s grandson said. And while he was aware of the government price cap, he did not know that the Karnataka government order specifically exempts private hospital suites from the price ceiling.
As per the June order, “An additional 10% may be charged for twin sharing wards and 25% more for single rooms (for those who don’t have insurance). There will be no ceiling for suites.”
According to officials with the Department of Health and Family Welfare, a suite is different from a private ward in terms of the facilities available. “Suites generally have automated beds, private bathrooms, which also have amenities for persons with hip surgeries and these suites also have television sets. While a private ward does not have these facilities,” the official said. He, however, did not provide a reason as to why suites are exempted from the price ceiling.
Akhila Vasan, a member of the Karnataka Janarogya Chaluvali, an organisation of health activists, alleged that private hospitals have been violating “every rule in the book”, especially during the pandemic, and are focused only on “generating more money” than view the situation from the perspective of community service.
“Initially all private hospitals were crying about how footfalls had drastically reduced and asked the government to give them subsidies. It is a pandemic and this is a time to serve the community. Here private hospitals are demanding government resources. When they finally got empanelled for COVID-19 treatment, they were overcharging, trying to mislead patients and taking payments from them and the government,” she said, while adding that the state government is not even in a position to enforce action against them.
She said that although the Commissioner of the Health Department, Pankaj Kumar Pandey has issued “warnings” to private hospitals, the government has not taken any measure to set an example to establish deterrence and ensure that private hospitals begin “toeing the line”. She said that the state government has powers under the Karnataka Private Medical Establishments Act to cancel the licenses of hospitals that violate norms, which it is not doing. “This is because the government has very little control of the private hospitals,” she added.
Karnataka Minister for Health and Family Welfare, Dr K Sudhakar told TNM that action has been taken against private hospitals that were found to have overcharged patients.
“There have been incidents in the past where few hospitals including one Apollo Seshadripuram have overcharged the patients. I have issued notices to such hospitals and they have refunded the excess money charged to the patient family. Strict action will be initiated against the erring hospitals breaching the price cap prescribed by the government. Government is ensuring all facilities available for the general public at COVID-19 designated hospitals and government hospitals,” he said.
He said that cases would be filed against hospitals found violating the government’s orders under the Disaster Management Act. “As I have already said, violation of state government guidelines by charging in excess while treating a COVID-19 patient is considered as a criminal offence and will be liable for action under the Disaster Management Act. However, I request the citizens to bring in such incidences to the notice of the government for further action,” he added.
If you have been admitted to a private hospital and were charged more than the amount capped by the government, you can reach out to the SAST’s toll-free numbers 1800-425-8330 and 1800-425-2646 and lodge a complaint. You will be asked to provide copies of your hospital bills. SAST will help you get the extra money back even if you were not admitted under the government quota.
*Names changed