Many patients undergoing treatment at private hospitals in Kolkata and their relatives are facing an old problem again.
They are having to pay more for procedures, diagnostic tests and doctors’ visits because they had chosen a more expensive bed than what is covered by their medical insurance policies.
The West Bengal Clinical Establishment Regulatory Commission, the regulatory body for private healthcare institutes in Bengal, had in 2017 issued a notice saying there was no basis for levying differential charges for diagnostic and pathological tests, medicines and doctors’ visits based on the rates for the beds or rooms patients opt for.
Insurance companies said such practices had gone down significantly but as things started returning to “normal” post-Covid, they are again getting claims with such differential charges.
Private hospitals alleged some insurance companies were deducting reimbursement amounts if a patient chose a higher category bed or room than what is covered by the policy even though there are no differential charges.
Several patients said that ultimately they were having to pay from their pockets despite having a medical insurance policy if they chose a higher category bed or room.
A businessman in Gariahat said he had to get his mother-in-law admitted several times at a hospital in south Kolkata because of a recurring kidney infection.
“During the first admission, she got a two-bed room and the doctor’s fee was Rs 900 for every visit. Next time, she got a single-bed room and the doctor’s fee was Rs 1,200 for each visit,” he said.
A south Kolkata resident had admitted his mother to another private hospital for a knee replacement surgery a couple of months back.
“My mother was entitled to a four-bed ward. We requested the hospital to provide her a single-bed room and told them we would pay the extra amount from our pocket. The hospital’s insurance desk provided us with two estimates for two categories of rooms and said the cost of the implants would be more if we opted for a single-bed room,” he said.
The state’s regulatory commission for private healthcare institutes had issued a notice on May 26, 2017, stating: “... it has also been brought to the notice of the Commission that some clinical establishments link the standard of diagnostic/pathological test of in-patients to the standard of bed/room they occupy. For example, a patient occupying a cabin/bed/room of lower value has to pay a lower fee for tests than that charged for similar tests for a patient occupying higher value cabin/bed/ room.
“The Commission, prima facie, is of the opinion that there is no basis for levying differential charges for diagnostic and pathological tests, drug prices or doctor’s fee linked to the rate that a patient pays by occupying a certain category of room/cabin/bed.”
State health department officials said the commission had sought feedback from hospitals in this regard.
“There were several meetings with the private hospitals where the commission had requested them not to levy differential charges,” said a health official.
Insurance company officials said that after the notice and meetings, complaints from policy holders regarding differential charges had gone down.
“But recently, the complaints have gone up again. About 25 per cent of the complaints we receive now are regarding differential charges which had gone down to below 15 per cent of the total complaints,” said Saurav Kariwala, assistant manager (medical), National Insurance Company Ltd, Kolkata.
“We have to deduct the excess amount charged by the hospital in the bill for implants, diagnostics, pathological tests and doctor’s fee for a patient who had stayed in a higher category room than what he or she is eligible according to the medical insurance policy,” said Kariwala.
Some of the hospitals said they levy differential charges to provide subsidy to the patients who get admitted to lower category of beds.
“This is a cross-subsidy model. We charge a patient on a lower category bed less for diagnostic or pathological tests or doctor’s consultation compared with a patient on a higher category bed to meet the cost. This has proven beneficial for everyone. This is the standard practice for private healthcare industry across categories,” said Rupak Barua, president of the Association of Hospitals of Eastern India and group CEO, AMRI.
However, the head of one private hospital in Kolkata said costs could be met without differential bills.
“In hospitals where the number of private and semi-private rooms are much less compared with general wards, the scope of recovering additional amount by charging more for tests and implants is insignificant. So differential charges are not necessary,” he said.
He pointed out that often doctors charge more for ICU visits because of the criticality of the patients and the more time they have to spend.
Some hospitals claimed they don’t levy differential charges. “We don’t have differential charges for any category of beds except for the bed charges. However, most insurance companies still deduct from amounts payable to the patient if they choose a higher category bed,” said Sudipta Mitra, chief executive of Peerless Hospital.