No insurance? Be prepared to pay more at hospitals | News of India – Times of India

Did you know that your hospital bill is likely to be higher, not lower, as many believe, if you pay it yourself instead of an insurance company? A patient in Gurgaon discovered this to his horror recently and TOIInquiries reveal that this is common practice.
When this patient, while being discharged after three days of treatment, decided to pay the bill out of pocket instead of waiting for insurance approval, he found that the bill had increased by around of 27%. The hospital insisted it was standard practice for the patient. bill to be more if a patient pays directly. Too tired and sick to argue, the patient was forced to pay the higher amount.
The 53-year-old patient, who was admitted to Gurgaon’s Fortis Hospital with suspected food poisoning with fever, severe dehydration and diarrhea on April 14, was given a double room to share, for which he was charge 8,400 rupees per night, similar to that of the patient. the room rate at a posh hotel in Gurgaon for a single room, except here, everything from nursing, linen and laundry to admission charges and waste disposal biomedical, was charged separately from the room rent.

They delayed informing my insurance company even though all details including policy number and aadhaar card were given at the time of admission. This delayed the approval process. The doctor informed me on the evening of April 16 that he would discharge me the next day. I received a message from my insurance company at 20:07 on April 16 that they had received the claim. If I was admitted at 9.30pm on April 14, why did it take two days to tell the insurance company? We waited all day until 7.30pm on 17th April for insurance approval. Finally, tired of waiting when I offered to pay, they raised the bill, the patient complained. As of April 27, the insurance company had not processed his request for reimbursement.
TOIs inquiries revealed that it was indeed common practice for hospitals to have discounted rates for insurance companies and higher charges for patients who chose to pay themselves. However, this is not disclosed to patients and there are no boards posted outside hospitals that give the difference in rates charged to insurance companies and direct patients. In many hospitals, the difference is about 10%. It’s bad enough that there is a difference in rates for direct paying patients and insurance companies. Charging a patient 27% more is normal loot. Either way, the direct-paying patient should get paid less, since the hospital gets the money right away instead of having to wait through the approval process and back-and-forth with the claiming insurance company. several clarifications on the invoice. In fact, many smaller hospitals charge the patient less if they pay directly, one doctor explained. Several other doctors who TOI spoke to echoed his words.
According to a TPA representative, Anurag Goswami, insurance companies sign MoUs with hospitals to get negotiated rates. For starters, they see themselves as customers and not patients. Our clients receive the negotiated rates. If the customer goes directly, the amount will vary. We have discounted rates because we bring them business/clients. These rates vary for different insurance companies. Sometimes, if a customer requests it, they can get some discount. In case of insurance through a bank, if there is any fraud you can complain to the RBI. In the case of an insurance company, you can complain to the IRDAI. If a private hospital commits fraud, you can’t go anywhere because they have no government authority. They know it. That’s why they charge individual customers whatever they want, Goswami said.
In response to TOIs enquiries, Fortis Hospital, Gurgaon replied: We initially offered hospital rates as per our contractual obligations with Manipal Cigna Insurance (Mediassist – TPA) for your hospital stay. However, due to multiple inquiries and delays in insurance approval, the patient requested to settle the bill and seek reimbursement from the insurance company later. Consequently, as standard practice across the industry, standard hospital rates were applied and contractual discounts with Manipal Cigna were removed, leading to an increase in the bill amount.
The two invoices