A Covid patient’s family had to beg and borrow to raise Rs 2.5 lakh for his treatment after the insurance company rejected their cashless claim.

It has been more than two months now but the patient, a 37-year-old hawker from Posta in Burrabazar, has yet to get the reimbursement because, the family alleged, the hospital’s bill lacks transparency and there were overbillings.

Vicky Sonkar, who has a stall on a footpath at Raja Katra market in Burrabazar, had tested positive for Covid-19 and got admitted to Flemming Hospital in Topsia on July 9. He had bought a health insurance policy from HDFC ERGO, a private company, earlier this year.

Sonkar was discharged from the hospital on July 16. During discharge, he came to know that the request for cashless admission was rejected by the insurance company and so the family had to arrange for the money. He later submitted the bills provided by the hospital for reimbursement but they are yet to be cleared because HDFC ERGO is said to have sought clarifications on the bill, which amounted to Rs 2.49 lakh.

“We had called many hospitals but they either said there was no bed or asked for exorbitant amounts of money. One private hospital said Covid treatment would cost around Rs 12 lakh and another said Rs 10 lakh,” Sonkar said on Wednesday.

“I run a small stall on the footpath. How would I arrange so much money?” Sonkar, a resident of Posta in Burrabazar, said. Then someone told him about Flemming Hospital, where the charges would be less.

“When my parents called up the hospital, they said the treatment could cost Rs 2.5 lakh,” said Sonkar. “I had to get admitted because at that time if someone had Covid, neighbours were getting scared and the patient was being abandoned.”

He had submitted to the hospital the documents of the insurance coverage but the claim for cashless treatment was rejected, said Sonkar.

“The hospital said I had to pay the money to get discharged because the insurance company had rejected the cashless request. My parents had to beg and borrow the money from relatives to get me discharged,” said Sonkar. “Till now I have not got the reimbursement. The insurance company has told me that they are investigating the bill and it would take some time.”

The bill, submitted to the insurance company by Flemming Hospital, shows the bed charge for a day was Rs 17,000. It was Rs 13,000 a day for the rest of the stay at the hospital. Besides, the hospital had billed Rs 32,000 for doctors’ visits for seven days.

In June, chief minister Mamata Banerjee had announced that a hospital could not charge a Covid patient more than Rs 1,000 a day for doctors’ consultation.

The bill also shows Rs 8,000 was charged for air mattress, which, doctors said, is used for patients who are immobile. Air mattresses prevent bed sores. Sonkar said he could sit and move around and he was not sure whether an air mattress was given to him by Flemmings.

The bill shown to Metro does not have details of the charges under the heads of pharmacy, pathology, radiology, etc. “Insurance companies usually reject documents sent in this format,” said the CEO of a private hospital, whom this newspaper had sent the bill. “A proper bill needs to have details charged for every investigation, consumable, non-medical item etc.”

A Flemming Hospital official said he would not be able to comment without seeing a copy of the bill. This newspaper sent him a copy by WhatsApp on Wednesday afternoon, but he did not get back till late in the evening.

An HDFC ERGO spokesperson said the company would not be able to comment on this case.

There have been a lot of complaints over bills lacking transparency against private hospitals.

“Initially, there were complaints from patients about testing. Then it was about not getting beds. Now, we are getting most complaints against private hospitals about billing,” said retired judge Ashim Kumar Banerjee, the chairperson of West Bengal Clinical Establishment Regulatory Commission, the regulatory body for private hospitals.

Insurance professionals said lack of transparency in billing had been a huge problem during the Covid-19 pandemic.

“Many hospitals submit bills that have no details. These bills cannot be accepted. But in the end, it’s the patient who is suffering because that person is forced to pay and then get discharged,” said Dipayan Saha, a doctor who handles claims for a private insurance company.