Varying corona packages lead to wrangle between insurers, hosps

Varying corona packages lead to wrangle between insurers, hosps

Rachel.Chitra@timesgroup.com

10.06.2020

With metro cities seeing an increasing number of Covid-19 patients availing treatment in private facilities, insurers and hospitals are wrangling over bills which range between Rs 1lakh and Rs 8.5 lakh.

Insurers say they do not make a judgment call on whether the patient requires hospitalisation, which increases prospects for “soft fraud” through unjustified charges. There have been over10,000 private healthcare claims. The average bill of a Covid-19 package in India is Rs 1.56 lakh so far, as per IRDAI data. Insurers say that claims range from Rs 2 lakh to Rs 8 lakh but pay only what has been agreed upon in insurance contracts with the rest borne by the insured.

“You see hospitals billing patients for sanitising equipment. Does that mean they were using unsanitised equipment earlier? With Covid-19 we are seeing hospitals billing anything and everything,” said the CEO of a private general insurance company. Insurers say that where the bill is borne by the patients, the charges are higher as there is no insurance company to negotiate.

Delhi resident Surender Gaur claims his brother’s bill of Rs 4.08 lakh had Rs 70,900 earmarked for PPEs. He alleges that his brother was billed for 22 visits by a specialist doctor as against seven visits.

Guj has lowest treatment cost for Covid-19

Chennai resident B Manikandan alleges that his father was billed Rs 4.8 lakh for Covid treatment of which Rs 75,000 was charged for a ventilator, which was never used. Insurers are also disputing add-on charges to the Covid test. The average Covid-19 claim size is highest in Kolkata (Rs 2.5 lakh per patient), followed by Delhi (Rs 2.41 lakh). Hospitals in Mumbai and Pune are reporting claims of much lower value at Rs 1.19 lakh per patient. In Surat and Ahmedabad, the average cost of Covid-19 treatment is the lowest in India at Rs 97,000.

Insurers also say that for cities like Mumbai and Chennai, initially hospitals were charging a lot but have now reduced rates due to various reasons. The Tamil Nadu government has capped daily charges at Rs 5,000 a day for Covid-19 patients, which has reduced the average claim size to Rs 1.93 lakh.