With metros seeing an increasing number of Covid-19 patients availing treatment in private facilities, insurers and hospitals are wrangling over bills which range between Rs 1 lakh 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 over 10,000 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 cla ims 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 where the bill is borne by patients, the charges are higher.
Delhi resident Surender Gaur claims his brother’s bill of Rs 4.08 lakh had Rs 70,900 earmarked just for PPE kits. He also alleges that his brother was billed for 22 visits by a specialist doctor as against seven visits. 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 addon 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.
“This data could also indicate that cases in Maharashtra are of lower intensity and require less medical attention, whereas in Kolkata cases are more critical, requiring the use of ventilators,” said an official with the National Health Authority of India.
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. In Maharashtra, there is also government pressure.