Written by Amit Chhabra
Recently, Delhi resident – Mr Sandeep Thakur got his 63-year-old father – Mr Sudhir Singh admitted to a prominent New Delhi hospital after his father tested positive for the novel coronavirus. Mr Singh was admitted on the morning of 26th May and was discharged on 7th June late evening. For his treatment – that went on for 13 days – the total hospital bill stood at Rs 3.33 Lakh.
Sandeep was quite relaxed as he had a family floater health insurance cover with Rs 20 Lakh sum insured which covered his father as well. He was sure that the entire hospital bill will be taken care of by the insurer as there wasn’t any co-payment clause attached with the policy. However, while settling the claim with the insurer at the TPA desk of the hospital, Sandeep was shocked to hear that his insurer will only pay Rs. 2.01 Lakh of the entire bill amount as the remaining Rs. 1.32 Lakh i.e. almost 40 per cent was billed under ‘Medical Consumables.’
Unfortunately, just like many others, Sandeep was unaware of the fact that a health insurance policy generally does not covers the cost of most medical consumables used in the treatment of a specific disease or condition during hospitalisation. Medical consumables usually cost not more than 10 per cent or so of the total hospital bill, however, in case of COVID-19 it has been observed that just like in the case of Sandeep Thakur, the cost may go as high as 40 – 50 per cent of the total treatment cost. Under COVID-19, medical consumables or non-payable items include PPE kits, N-95 masks, face shields and shoe covers.
Rise in hospital bills
Hospitalisation amidst the ongoing COVID-19 pandemic, even if a patient has not tested positive for the novel coronavirus may add several thousands of rupees in out-of-pocket expenses as insurers are unwilling to cover the costs of personal protective gear under the insurance policy as they fall in the list of non-payable items. COVID-19 positive patients could end up spending as much as half of their hospital bills and non-COVID patients a fourth of their hospital bills on personal protective equipment (PPE) during an extended hospitalization. This is because, considering the highly contagious nature of the deadly virus, hospitals have made it mandatory for their entire staff to wear protective gear, including bodysuits and face shields, which indirectly adds to the costs of patients.
However, it is not just the cost of PPE kits that is responsible for the steep rise in the hospital bill but there are other consumables as well included in the hospital bill. With the rise in the number of COVID-19 positive cases, the demand for consumables and surgical accessories like crepe bandage, tissue paper, slippers, gown, foot covers, disposable gloves, sheets, syringes, masks etc. has also gone up in the hospitals.
The mandated quarantine period of 14 days is also an important reason for the significant rise in the cost of consumables. Another critical reason for the increase in hospital bills for COVID-19 patients is the need for social distancing of patients. While earlier i.e. before the spread of coronavirus, in a hospital ward where there were 20 people who used to get treated, now the number has decreased to 10 people in a ward. In order to keep a check on your hospital bill, customers must always keep a check with the insurers about what all is covered under the health insurance plan and what all is not.
Buy health insurance wisely
As per the Insurance Regulatory and Development Authority of India (IRDAI), it is entirely the insurers prerogative to include or exclude consumables like PPE Kits in their health covers and charge premium accordingly. Though it has been observed that most of the health insurance policies where the premium is priced low usually will reasonably cover some of these consumables but if the policy is priced well and if it is a high-end policy, the insurer usually covers all types of accommodation and most of the consumables that are used at the time treatment during hospitalisation.
With the number of COVID-19 positive cases rising exponentially in India every day, even the regulatory body is putting in efforts to help the customers wherever possible. IRDAI in one of its guidelines issued in September last year directed the insurers that costs of room charges or procedure charges specified or costs of treatment (including costs of diagnostics) are to be covered under health insurance and claims shall be settled in accordance to the terms and conditions of the policy contract.
It is important for the insurers to put in place measures to ensure that items which are part of room/surgical procedure/treatment (including diagnostics) shall not be billed to the policyholders by the hospitals and every insurer shall inform or notify the same to the hospitals and the policyholders suitably. Items that need to be subsumed into procedure charges and cost of treatment include Gause Soft, Gauze, Surgical Drill, Eye Kit, Cotton Bandage, Apron, etc.
For people planning to buy a health insurance policy anytime soon or if your health insurance policy’s renewal date is nearby, it is advised to check with the insurer whether your policy covers such consumables or not. Currently, only very limited health insurance plans are available in the market that cover consumables used in the treatment of Covid-19 while processing a claim. It is important to check the detailed list of consumables in the policy document as the list of non-payable consumables varies from insurer to insurer.
The author is the Head- Health Insurance at Policybazaar.com. Views expressed are that of the author.
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