Many private hospitals in Calcutta on Sunday said they would seek a Rs 50,000 deposit even from patients with cashless insurance policies, highlighting that the state regulatory commission’s day-old advisory allowing deposits stipulated no exceptions.

Saturday’s advisory from the West Bengal Clinical Establishment Regulatory Commission has capped the deposits at Rs 50,000 or 20 per cent of the estimated bill, whichever was less.

On Sunday, commission chairperson and retired judge Ashim Kumar Banerjee told The Telegraph that the exception for holders of cashless policies was implied. “The private hospitals cannot demand deposits during admission from patients with cashless insurance policies. Otherwise what’s the point of someone having such coverage?” he said.

But officials with several hospitals and insurance companies contended that since the advisory contained no clause saying deposits could not be demanded from beneficiaries of cashless insurance policies, the hospitals would be justified in seeking deposits from such policy holders.

Asked, Banerjee said such policy holders can lodge a complaint with the commission through email if a hospital demands a deposit.

Sudipta Mitra, chief executive of Peerless Hospital, said: “There is no separate mention of insurance patients in the advisory. So, it is clear that there is no bar on seeking deposits from patients under cashless insurance coverage.”

A clause in the agreement between a particular private hospital in Calcutta and the preferred provider network —a consortium of four insurance companies — states the hospital should admit insured patients without seeking any deposit or advance payment.

“Now the state government's new advisory will override this clause, like it happened with the personal protective equipment rates the patients are charged for,” an official of the hospital said.

When the Covid-19 epidemic broke out, the private hospitals began charging varying amounts for the PPE kits their healthcare workers had to wear to treat the patients. This prompted chief minister Mamata Banerjee to cap the PPE charges at Rs 1,000 per patient per day, and the hospitals and insurance companies abided by it.

Several hospitals, including Peerless, said their agreements with insurance companies had no clause about not seeking deposits from cashless policy holders, anyway.

“We have been seeking deposits from patients within the limit of Rs 50,000 from the start of the Covid-19 outbreak to keep the hospital viable,” said Pradip Tondon, CEO of Belle Vue Clinic.

“Patients with cashless insurance benefits are also being asked to pay the deposit during admission. This is because disputes often break out over payment of the amount not approved by the insurance company.”

Tondon said that when a hospital sends a patient’s bill to the TPA or third-party administrator, the insurance company usually refuses to pay a portion of it -- particularly the charges relating to bed occupancy, certain investigations and the use of equipment such as gloves.

“Usually, the amount not paid by the insurance companies even in the case of cashless policies varies between Rs 25,000 and Rs 1.25 lakh,” Tondon said.

The CEO of another private hospital said that many patients, especially Covid-19 patients, were now refusing to pay the amount not approved by the insurer because the bills often ran into several lakhs — far beyond the sum they were insured for.

“It has been an understanding of many years that hospitals would not ask for deposits from patients under insurance coverage,” said Saurav Kariwala, assistant manager (medical) with the National Insurance Company Ltd, Calcutta. “They often asked for small (deposit) amounts that we ignored. Now we fear that the deposits will become the norm.”

THE CLAUSE

An agreement between a private hospital in Calcutta and the preferred provider network (PPN), a consortium of four insurance companies, states:

Deposit And Advance Payments — In all fit cases meeting with the prescribed parameters for cashless admission, the Network Provider (hospital) shall admit, on priority and expeditiously, a Beneficiary to the Hospital for the purpose of Treatment without seeking any deposit or advance payment from the beneficiary or the TPA (third party administrator).

(An official of the hospital said the agreement was in force till July this year and should have been renewed with the same clause by now. But because of the Covid-19 situation, the renewal has got delayed.)