Overbilled At Hospital: Here’s What Every Policyholder Must Know

Since medical costs are rising rapidly, insurance is a must. However, some hospitals may charge you more just because you are insured by a health insurance cover. This might be a concern, especially if the treatment does not fall under a pre-listed package.

Says Sarita Joshi, head, health and life insurance, Probus: “Bill inflation in insured cases is a documented concern. It’s not a blanket practice across the board, but it’s prevalent enough to warrant attention. This often stems from a perception that the “payer” is the insurance company, not the individual.”

As a result, some hospitals may add unnecessary line items, overuse diagnostics, or choose more expensive treatment options. This is exactly why insurers are moving toward cashless networks with pre-approved treatment packages and cost controls in place.

Here is how to ensure that you do not pay more, just because you are insured.

What You Should Do To Avoid Being Overbilled 

If it is a networked hospital, you will get a pre-authorisation from the insurance company for the treatments to be done and the costs to be incurred. You must ensure that the hospital is not over-billing you beyond the approved amount.

“In case there is doubt, the insurance company or the third party administrator (TPA) should be contacted so that the billing is corrected. If the policy is being serviced by a broker or agent, they can also assist in resolution,” says Hari Radhakrishnan, expert, Insurance Brokers Association of India (IBAI).

So, as a first, look out for vague package deals with minimal breakdown. Always ask for an itemised bill. Repeating tests unnecessarily, especially if done just days before hospitalisation, is a common tactic. Items, such as gloves, syringes, and disinfectants are often overcharged or duplicated under various headings. Sometimes, a patient is shifted to the ICU even when not medically necessary, just to inflate the cost. Adds Joshi: “Always remember, policyholders should not hesitate to ask questions—transparency is a right, not a request.”

Take Steps If You Are Overbilled 

One should get an estimated cost before agreeing to admission, and then compare it to their insurer's standard treatment packages or online hospital pricing databases. File a formal complaint with the insurer if you believe there has been overbilling.

“Policyholders have the option to escalate the matter to the Insurance Regulatory and Development Authority of India’s (Irdai’s) Integrated Grievance Management System (IGMS) if it remains unresolved,” says Joshi.

Also, ask the hospital's billing desk for clarification if you see any odds. Hospitals must provide thorough, justified invoices.