Not every hospitalisation experience is smooth sailing, often some patients face troubles at the moment of discharge. A recent ruling by Delhi High Court brought focus to this issue faced by many health insurance policyholders.
The ruling highlights that leaving the hospital is not always about medical readiness, sometimes it can be about who paid how much, and whether the insurance company has cleared all your dues in full.
What was the case?
The case which highlighted this issue was filed by Shashank Garg, an advocate. He was a policyholder under Max Bupa Health Insurance and had a cashless facility at his disposal. The claimant was diagnosed with a neurological condition and was admitted to Max Hospital in Saket, New Delhi, for a surgery.
Typically, with a policy that comes with cashless claim settlement, one would assume a simple procedure at the time of hospitalisation. However, for Garg, it was not.
Despite having a partial pre-authorisation of Rs 75,000 from the insurer, Garg was allegedly forced to deposit Rs 1.45 lakh in advance just to ensure that the surgery happens.
On the day of discharge, even with the insurance company later approving the whole claim of Rs 1.73 lakh, Gard claimed that he was not allowed to leave the hospital until the funds were received.
This led to a delay in his discharge till late evening. Garg also claimed that he had to pay Rs 57,000 extra despite the insurer’s full coverage, and the refund process only began after multiple arguments.
The allegations were imposed as ‘wrongful confinement’, ‘misappropriation of funds’, ‘breach of trust’ and deliberate overcharging by the hospital. The hospital, however, denied any wrongdoing and pointed out the standard industry procedures and norms set up by the Insurance Regulatory and Development Authority (Irdai).
This situation highlights the high emotional and financial stress patients face during hospital discharges. This is not just about one hospital or one insurance company, since recently many people have flagged the issues with claim settlement even with cashless facilities.
“Before parting, it would be pertinent to record that such incidents of alleged harassment felt by the patients in settling their Final Bills, is not an untold story but is frequently suffered by the patients,” the Court stated.
The concerns are flagged regarding billing, wherein the billing departments often take precedence over medical advice. Sometimes the patients, despite being insured, feel like they are negotiating their way out of confinement.
The Court further noted that much angst has been expressed on this system of getting the approvals from the Insurance Company at many forums and by the Courts, but such a situation may be a ground for seeking compensation for mental harassment but does not tantamount to any criminal offence.
It also noted that before this, many Courts have recommended that there may be some Regulatory Policy and even a Charter of Patients Rights, has been proposed by NHRC but unfortunately, no final redressal to this aspect has been worked out till date.
Therefore, taking cognisance of this problem, the Delhi High court, in its ruling, asked the Centre and Delhi government to work on a mechanism that should streamline the claim settlement of medical bills by insurers so that patients or policyholders are not harassed or denied timely discharge by hospitals.
The Court further directed the Centre and state government to work in unison with Irdai and medical councils of Delhi and India to develop this system.
