Bengal commission seeks affidavit from Medica on discount to patients

The clinical establishment commission on Monday asked Medica hospital to file an affidavit stating that it would offer discounts on medicines, consumables and pathological tests on the part of the bill a patient has to pay, even if an insurance company pays the rest.

The commission’s chairperson, retired judge Ashim Banerjee, said the regulatory body for private hospitals had made it clear earlier, too, that a healthcare institute could charge its own rates if the bill was paid fully by the insurance company.

But discounts have to be offered on the part of the bill a patient or his or her family pays.

The commission’s order on Monday followed a revelation that Medica Superspecialty Hospital had not offered discounts on medicines, pathological tests and consumables.

The hospital told the West Bengal Clinical Establishment Regulatory Commission during the hearing that the discounts were not offered because the patient was covered by medical insurance, Banerjee said.

The treatment cost Rs 14 lakh, of which the patient had to pay Rs 11 lakh and the rest was paid by the insurance company.

“A hospital can charge according to its own rates if the entire cost of treatment is paid by the health insurance company. But discounts on consumables, medicines and pathological tests have to be offered even if the patient pays a part of the bill amount,” said Banerjee.

“In that case, the discount will be effective on the portion of the bill paid by the patient party. The hospital can charge its own rates on the portion cleared by the insurance company.”

Alok Roy, chairperson of Medica, said he would be “in a position to comment only after reading the written order”.

An official of Medica said the rates charged for the portion paid by the patient was similar to the rates decided by the insurance company. “Insurance rates are always lesser than rates for cash patients. So the question of applying discounts advised by the commission does not apply here. The rates charged were already lesser,” said the official.

Banerjee said on Monday that the commission would send a copy of the Monday’s order to all private hospitals as a reminder that they could not charge their own rates on the portion paid by a patient.

In August 2020, the commission had issued advisories asking private hospitals to offer at least 10 per cent discount on medicines and 20 per cent discount on consumables.

Consumables include gloves, personal protection equipment and masks. The commission had also said that if hospitals were unable to offer the discount, they should allow a patient’s family to buy medicines and consumables from outside.

In July last year, the commission had fixed a limit on the rates that private hospitals could charge for a number of pathological and radiological tests. The advisory capped the chest X-ray PA rate at Rs 400 and the HRCT (128 slice CT scan) rate at Rs 5,200. Among pathological tests, the procalcitonin test rate has been capped at Rs 4,000 and the IL-6 test rate at Rs 3,500.

Days after issuing the advisory, the commission clarified that the cappings would not apply to patients with medical insurance. Several private hospitals had opposed the commission’s decision to put a price cap on pathological tests.