Medical insurance claims of many dengue patients in Kolkata are getting rejected because the insurance companies feel they did not require hospital admission.
A woman was recently admitted to a private hospital in south Kolkata after testing positive for dengue. Her platelet count was 1.6 lakh per microlitre and she had no other complications, said an official of the hospital.
“The insurance company rejected the claim because they said there was no need for admission. The family had insisted that we admit the woman, so we admitted her,” said the official.
Health insurance companies and doctors said family members of many dengue
patients are getting panic-stricken and often forcing hospitals to admit the
patients.
Besides, some private hospitals and nursing homes are often not following the protocol while admitting a dengue patient.
“We are getting many claims for dengue patients, where, after scrutiny, we are finding that the hospital admission was not required. So, in those cases we are rejecting the cashless as well as post-admission reimbursement claims,” said Saurav Kariwala, deputy manager of Calcutta Health Hub, National Insurance Company Ltd.
Kariwala said the Calcutta hub of National Insurance receives around 300 claims every day on an average. “Now, 15 of 16 of those claims are for dengue. Of these, five to six are being rejected because admission was not required,” said Kariwala.
“We allow claims if we are convinced that the management of the dengue patient was not possible at home,” he said.
According to officials of private hospitals and doctors, family members of many dengue patients are requesting admission despite the absence of alarming symptoms such as bleeding, disorientation, continuous vomiting or highly abnormal irregular blood parameters.
“Several patients are coming to the Emergency ward and requesting admission. But their parameters are normal. So, I am advising them to be under medical supervision at home. However, some of them are returning to the hospital and getting admitted after two or three days as blood reports are showing abnormal parameters, such as low blood platelet count and high packed cell volume count,” said Chandramouli Bhattacharya, infectious disease specialist at Peerless Hospital.
“Also, there is a high demand for hospital beds now. We have to accommodate those patients who need admission,” said Bhattacharya, stressing the need for patients with normal parameters to stay at home.
Several hospitals said they were getting requests for admission from panic-stricken dengue patients and their relatives.
“We are facing such demands everyday now. Our doctors are counselling such patients to get treated at home,” said Rupak Barua, group CEO, AMRI Hospitals.
The three units of the chain had 95 dengue patients admitted on Thursday. Twelve of them are in ICUs.