Delay in patient discharge because of pending insurance approval and daycare procedures and consumables still remaining outside the ambit of insurance claims were issues highlighted by the state clinical establishment regulatory commission in a meeting with representatives of insurance companies and third-party administrators on Monday.
The commission said it will soon hold a meeting involving hospitals and insurance companies to discuss such issues.
The insurance companies told the commission that hospitals with similar facilities charged different rates for the same treatment.
“A common problem faced by patients is the long delay in discharge. The doctor may have written the discharge advice, but patients remain stuck in the hospital awaiting insurance approval,” said retired judge Ashim Banerjee, the chairperson of West Bengal Clinical Establishment Regulatory Commission.
Banerjee said the insurance companies blamed hospitals for not uploading documents properly.
“We told them hospitals blame them and they in turn blame the hospitals. This will not help. The patients and their families suffer. We said that, at no cost, the patient’s discharge can be delayed. This issue will be discussed in the tripartite meeting,” said Banerjee.
Items not covered by insurance were a major problem for patients since the hospitals charged a large amount of money to the patients on these accounts.
“We highlighted the absence of consumables within the ambit of insurance coverage. Hospitals charge quite a premium for consumables. Some company representatives told us that their companies were already working on whether they can bring consumables within the ambit of insurance,” added Banerjee.
“We also pointed out that day-care procedures were not covered in insurance. Hospitals often admit a patient because day-care procedures are not covered, and then the patient is made to stay for two or three days. This way, a lot of money is charged,” added Banerjee.
“About four or five months back, an insurance company approached us about a case where a hospital had made fraudulent claims, and this came to light during the audit. We told the company that we cannot hear such piecemeal complaints, and all of them should come together. We had that meeting today,” said Banerjee.
He said that the fraudulent claims included billing for medicines that were not administered, breaking one surgery into three, and claiming money for a treatment that was not done.
Representatives from eleven major insurance companies and third-party administrators attended Monday’s meeting.
National Insurance, Oriental Insurance, General Insurance Corporation of India and United India Insurance were the PSU companies that attended the meeting. From the private sector, HDFC Ergo, ICICI Lombard and Star Health Insurance were some of the companies that attended the meeting, commission officials said.
“We will meet the hospitals based on what was discussed today. We will then have the tripartite meeting with hospitals, insurance companies and the commission as representatives of patients,” Banerjee added.
He added that the companies were asked to be as transparent as possible. This will help patients know what they were entitled to and what remained outside insurance coverage.