Insurers making massive deductions in Covid mediclaim bills

Nagpur: Getting Covid-19 is not the only shock for patients in the city. While private hospitals are refusing cashless treatment for those having insurance, a second shock follows when insurance companies finally settle the bills. The reimbursement patients are getting from insurers is coming only with hefty deductions.

TOI learnt from a cross section of insurance brokers and agents dealing in health insurance that as much as 40% of the amount claimed by the patients from insurance companies is not reimbursed. This is mainly because close to half of the bills has expenses that are not covered by policy.

The deduction from claims on account of hospitalization for other ailments does not go beyond 10% to 15%. Hefty room rents charged by the hospitals is one of the major reason. Private hospitals roped in for Covid-treatment have to charge at government rates for 80% of their beds. For the rest, hospitals can fix their own prices. Very high rates are being charged for these beds, said a source. The insurer does not pay for the additional charge.

“A private hospital has displayed room rent both at government rates applicable for 80% of the beds and rest of the capacity. For beds covered under government rates the charges are Rs4,000 a day. For remaining rooms they range from Rs15,000 to 25,000 a day,” a source said.

Another major component not paid by the insurance company is for drugs other than those officially recommended under the Covid-treatment protocol. The hospitals are prescribing a number of other drugs that are officially not part of the protocol. Termed as experimental drugs, the insurance companies are also striking off their cost from the claim amount, a source said. There are instances in which the hospitals have also charged for disposing of the material like PPE kits, said an advisor. These are also not reimbursed.

The hospitals here are refusing cashless treatment to ensure cash flow on their side. It takes at least a week for the insurers to process the claim and release the funds to the hospital. Instead, hospitals get ready cash if the patients pay upfront. Even the PPE kits are covered for up to Rs440 to 750 per kit though the actual amount billed is much higher.

Situation better in Mumbai

The situation is better in Mumbai where hospitals are allowing cashless treatments. According to details of a bill shared with TOI, a 62-year-old female patient had to pay around Rs10,000 as advance. The total bill came to Rs2.40 lakh out of which Rs1.50 lakh was approved under cashless scheme. The room rent was Rs1,500. Out of the deductions, Rs81,000 accounted for consumables alone.

Source: The Times of India

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