The state government has appointed the West Bengal Clinical Establishment Regulatory Commission as the arbitrator in cases where private hospitals feel they were denied their rightful due under the West Bengal Health Scheme by the state finance department.
Patients covered by the health scheme are eligible for cashless treatment of up to Rs 1.5 lakh in private hospitals. The hospitals later send claims for reimbursement to the state finance department.
If the treatment cost exceeds Rs 1.5 lakh, the patient or his or her family has to pay the excess amount but can claim reimbursement by the government later.
According to the state health department, the scheme has more than 8.5 lakh beneficiaries.
There are instances where the finance department does not reimburse the entire amount claimed by a hospital. Earlier, the hospital had to file an appeal with the state’s director of medical education if it felt that it had been denied its rightful due by the finance department.
In a notification issued last month, the authority to arbitrate in such disputes was shifted from the director of medical education to the West Bengal Clinical Establishment Regulatory Commission, which was set up in 2017 to adjudicate on complaints of malpractice against private healthcare establishments.
On Monday, Fortis Hospital told the commission during a hearing that it was not given about Rs 28,000 that it had claimed as reimbursement under the health scheme.
Retired judge Ashim Banerjee, chairperson of the commission, said Fortis had claimed Rs 1.5 lakh as reimbursement but was paid about Rs 1.22 lakh.
“We told Fortis that if they give us a written complaint, we will take up the matter with the government,” Banerjee said.
He hopes fewer patients covered by the health scheme would be turned away by private hospitals if disputes on reimbursements are resolved quickly.
Officials of many private hospitals have said the rates fixed for some of the procedures and treatments under the health scheme were too low.
An official at a private hospital said the cash flow would improve if the disputes were resolved quickly.
