The Hindu : Karnataka / Bangalore News : Are hospitals cashing in on fear of viral outbreak among people?

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Monday, Jul 27, 2009
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Are hospitals cashing in on fear of viral outbreak among people?

Afshan Yasmeen

‘There are different price lists for those with insurance and those without’

We have pre-determined price points: Wockhardt
‘Insurance companies have third party administrators’

Bangalore: “Tests for dengue and chikungunya done here,” reads a banner outside a diagnostic laboratory in Rajajinagar 6th Block. With Bangalore being witness to viral fever cases, it is “boom time” for hospitals and diagnostic laboratories. Patients allege that they are being fleeced, especially if they are covered under health insurance.

Sudeep Datta, who got his wife admitted for viral fever in a corporate hospital, ended up paying Rs. 64,000 for a six-day stay last week. Although it was not a financial burden on him because of the health insurance coverage, he had to pay Rs. 4,000 as his insurance coverage was only for Rs, 60,000.

“I had not expected such a large bill for viral fever and thought it would be in the range of Rs. 25,000 to Rs. 30,000. Besides, there was no indication that the bill would be so high,” a relieved Mr. Datta told The Hindu after getting his wife discharged.

But he had a doubt whether the bill shot up because of the health insurance. “The first thing that the hospital staff asked me was whether I had insurance. Then they asked me to pay an initial advance of Rs. 25,000. A series of tests was conducted after the doctors suspected it was dengue. We were asked to arrange for platelets and a few of my colleagues donated blood and the transfusion was also done. After all that, the doctors said it was mere viral fever,” Mr Datta explained.

The Hindu had reported recently that A.B. Satish, a resident of Mahalakshmi Layout, had spent Rs. 70,000 on treatment for his nine-year-old daughter for viral fever in two corporate hospitals.

Different lists

Some patients alleged that several hospitals had different price lists for insurance-covered and non-insurance covered patients.

“When we inform the hospital staff that we have health insurance, a series of tests is prescribed, probably ‘both wanted and unwanted’. By the time the ailment is diagnosed, our insurance limits would have crossed and we end up paying for the rest of the treatment. After the coverage limit gets exhausted, we cannot leave the hospital because going to another hospital would mean another series of tests and the resultant costs,” said K. Subramanya, a resident of Rajajinagar, who experienced these problems during the treatment of his son.

Doctors’ denial

But authorities in corporate hospitals deny that they differentiate between insurance and non-insurance patients. “We have pre-determined price points and all health insurance companies have third party administrators (TPAs) who act as a via media between hospitals and insurance companies. Insurance or no insurance, we have to follow the price mechanism,” said Vishal Bali, Chief Executive Officer (CEO) of Wockhardt group of hospitals.

Nagendra Swamy, medical director of Manipal Hospital, said that tests had to be conducted to rule out other serious ailments. “If we get a viral fever case, it is necessary to rule out that it is not dengue or chikungunya. Large hospitals such as ours cannot have different rates for insurance and non-insurance patients,” Dr. Swamy said.

Reacting to the allegation that the insurance amount is exhausted by the time the disease is diagnosed, Umapathy Palyala, Chief Executive Officer (CEO) of Apollo Hospitals, said such a thing would happen only if the coverage limit was low.

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