Rs 43,000 per day claims of coronavirus patients, Insurers fear huge losses in cashless treatment

NEW DELHI: Health insurance companies have started suffering Coronavirus with 90 patients having Covid-19 symptoms admitted to private hospitals across the country, till Saturday, filing treatment claims of more than Rs 1.95 crore.

The hospitalisation claims have exponentially grown — from an average Rs 1.65 lakh per patient in the initial few weeks to Rs 2.16 lakh at present with 82% of them still undergoing treatment. On average, per day claim of these patients is over Rs 43,000 when ICU with ventilator cost should not be more than Rs 10,000.

In one case in Gurgaon, the hospital has raised a claim of over Rs 6.70 lakh while the patient is still being treated. The insurance company, sources said, has cut down claims by 50% as it found many of the expenses booked by the hospital as avoidable. In yet another case of alleged over-billing, the insurer detected claims such as the use of 1,300 gloves for one patient in a week. When this was pointed out to the hospital, the administration withdrew it and requested not to publicise the case.

Many of the insurers have also pointed out overbilling on the use of PPE (personal protective equipment). Against a prescribed cost of Rs 2,000 for each set of PPE, many of these hospitals have been charging each patient over Rs 4,500 per day when one PPE per doctor is sufficient for up to 15 patients in a day-long shift. Sources say for an average length of stay (hospitalisation) of five days, Rs 6.70 lakh is way above a reasonable cost that should not exceed Rs 50,000 over a five-day hospitalisation considering an average per day Intensive Care Unit (ICU) cost of Rs 10,000 with the ventilator. “There is no treatment available for Covid-19, a critical patient is only provided with ventilator and treated with medicine used for influenza,” a senior health official said.

Hospitals cannot book unlimited doctor visits to a patient. As per present protocol, the advisable medical professional per patient in a hospital, or the doctor to patient ratio, ranges from 1:6 to 1:10, besides one nurse for each patient in a day-long shift. The doctor-patient ratio changes if it is an ICU where, as per norm, one doctor is sufficient for every 10-15 patients in a shift extending up to six hours. The cost of doctors and nurse per patient has to be accordingly distributed.

According to details available with the government as on April 4, only 12 of the 90 patients admitted to various private hospitals across the country have been discharged so far, two have died and 70 still undergoing treatment. Insurers have expressed fear that unless the government urgently comes out with a guideline regulating treatment costs, the Covid-19 coverage provided through cashless insurance cover will be difficult to sustain. “In absence of a standard operating procedure developed by the Centre for treatment of Covid-19 patients, these private hospitals are overcharging in many cases with no standardised rates or any treatment slabs prescribed,” the health official added.

According to sources, health insurance companies, as on April 4, have already settled Rs 66.66 lakh in claims filed by private hospitals concerning 27 patients. At present the billing variation is too wide in case of Covid-19 patients ranging from Rs 80,000 to Rs 6.70 lakh on an average length of stay of five days. The largest number of 31 hospitalisation claims has come from Mumbai, 11 from Gurgaon, six each from New Delhi and Kolkata and three each from Chennai, Pune and Rajkot besides others.

Source: The Times of India