Hospital Bills Still Lack Itemised Charges; 83 Per Cent Want Standard Made Mandatory

A hospital bill may arrive after a family has focused on treatment, but it can leave patients unclear about what they have paid for. Room charges, tests, medicines, consumables and doctor visits may be bundled into a package, making individual costs hard to check.

A LocalCircles survey suggests the Bureau of Indian Standards’ (BIS) voluntary format has not changed this practice for many families. Of 21,485 respondents whose family member had been hospitalised in the past 12 months, only 28 per cent said the bill listed every charge. Another 28 per cent said most charges were itemised. The remaining 38 per cent said many charges were clubbed together or the bill showed only an aggregate or package amount; six per cent could not say.

The survey received more than 42,000 responses across 306 districts. Of 21,231 respondents to a separate question, 83 per cent said it was “very critical” for the government to make the billing standard mandatory. Another nine per cent called it somewhat critical, taking the share that considered a mandate critical to 92 per cent.

A Voluntary Standard, Limited Compliance

BIS released IS 19493:2025 about a year ago. It sets out a uniform bill format requiring charges to be itemised under heads such as room, consultation, procedures, investigations, pharmacy and consumables, with unit, quantity, unit price and total for each. The standard followed a 2024 LocalCircles survey in which 47 per cent of families with a recent hospital admission said all charges were detailed. At the time, 74 per cent wanted a common standard made mandatory.

The comparison is not exact because the surveys used different time periods and response options. Still, the latest findings show full itemisation is not the experience of most respondents. Since the standard remains voluntary, hospitals can decide whether to follow it.

States Move On Billing Transparency

On October 12, the Union Health Secretary asked states and Union Territories to ensure clinical establishments prominently display rates for services and facilities. Existing rules require rates to be displayed in English and the local language. States where the central law does not apply were asked to enforce similar provisions under their own laws.

Karnataka has made itemised billing compulsory from November 1, 2026, for hospitals and other covered healthcare facilities, including outpatient services. Its order requires medicines, devices, implants and consumables to be listed separately with details such as batch number, expiry date, purchase price, maximum retail price (MRP), price charged and taxes. The price charged cannot exceed the MRP or an applicable ceiling. The order also provides for record-keeping, audits and action for violations.

Kerala has formed a panel to draft a law regulating private hospital charges. The proposed legislation is expected to cover advance disclosure of treatment costs, itemised bills and medicine purchase and sale prices.

The Supreme Court (SC) has also questioned steep mark-ups on cancer drugs and whether restrictions should extend to other medicines and medical devices. The matter is scheduled to be heard on October 27, the survey document said.

These measures may improve disclosure in particular states, but the BIS format is not compulsory nationwide. Patients can ask hospitals for an itemised statement and an explanation of package charges. A national mandate, supported by checks and a clear complaint process, would give families a consistent basis to review bills.

FAQs

What does the BIS hospital bill standard require?
IS 19493:2025 calls for charges to be itemised, with details such as quantity, unit price and total for each item.

Are hospitals required to follow the standard nationwide?
No. The BIS format remains voluntary. Some states are taking separate steps to require itemised bills or improve price disclosure.

What can patients do if their hospital bill is unclear?
Ask the hospital for an itemised statement and an explanation of package charges, including the cost of medicines, tests and consumables.