In a meeting with the representatives of insurance companies and third-party administrators on April 21, the state Clinical Establishment Regulatory Commission highlighted issues such as a delay in patient discharge due to pending insurance approval and daycare procedures and consumables still remain outside the ambit of insurance claims, according to a recent media report. To discuss such issues, the commission said that it would soon hold a meeting involving hospitals and insurance companies.
The hospitals with similar facilities charge different rates for the same treatment, the insurance companies told the commission. Ashim Banerjee, retired judge and the chairperson of the West Bengal Establishment Regulatory Commission, said that long delays in discharge is a common problem faced by patients. While the doctor may have handed out the discharge advice, the patients remain confined in the hospital awaiting insurance approval.
Banerjee also said that the hospitals are blamed by the insurance companies for not uploading documents correctly.
Banerjee said that the insurance companies criticize the hospitals, and the hospitals, in turn, criticize the insurance companies. And this does not help. He further said that the patients and their families suffer too. They said that the patient’s discharge cannot be delayed at no cost. Also, he said that this matter needs to be discussed in the tripartite meeting.
As the hospitals charge a substantial amount of money to the patients on these accounts, items not covered by insurance have become a major issue for the patients.
According to a recent report, Banerjee said that they have already focused on the lack of consumables within the insurance coverage space. Typically, hospitals charge a high premium for consumables. Some company representatives even told them that their companies were already working on whether they could bring consumables within the space of insurance.
Banerjee said that they had already pointed out that insurance did not cover day-care procedures. As day-care procedures are not covered, hospitals often admit a patient, and then the patient is asked to stay for two or three days. And this is how the expenses in the hospital shoot up.
Banerjee said that around four to five months ago, an insurance company approached them regarding a case where a hospital made fraudulent claims, and this became clear during an audit. They told the company that they cannot hear such disjointed complaints, and all of them need to come together. They had a meeting on that day.
