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Tuesday, July 07, 2020

Hospitalisation expenses for non-COVID & COVID treatment rise up to 50%: Insurers

A representation by FICCI on the costing of COVID-19 beds for the private sector estimated the cost of PPEs to run into around Rs 10,000 per patient per day.

Written by Prabha Raghavan , Sandeep Singh | New Delhi | Published: June 1, 2020 3:01:16 am
Emergency treatment, private hospitals expense, COVID-19 outbreak, Insurance firms, helath Insurance, Indian express Non-medical expenses, including disposables like gloves and PPEs, are usually not covered by insurance firms as per Irdai guidelines. (File Photo)

Emergency treatment at private hospitals during the COVID-19 outbreak in India has turned costlier, with the addition of essential protective gear for staff that facilities having been passed on to patients. Insurance firms have flagged yet another trend — rates for rooms in several large facilities have been hiked as much as 50 per cent in the last month, leading to some claims by hospitals being rejected or sent for revisions.

“Costs for non-COVID emergency admissions have gone up by 40-50 per cent for major private hospitals in Delhi, especially with the room rates. We have been receiving claims from hospitals for rooms that were set at Rs 6,000 a month ago, but are now around Rs 8,000-9,000. We have returned those bills back to the hospitals,” said a senior official with an insurance firm, who spoke to The Indian Express on condition of anonymity.

“Patients who have a policy with us are protected because we have visibility on the previous rates and can spot these changes in time to prevent it, but patients who do not have such a safety net are probably being charged higher,” the official added.

Maharashtra is among the few states that recently capped the rates for COVID and non-COVID treatment in the state to “redress” grievances regarding “exorbitant” amounts charged by healthcare providers to patients not covered under any health insurance. However, here too, some feel that hospitals have been given wriggle room to increase the costs of other elements that are not covered in these rate caps.

“It is still early days. While the announcement happened a few days ago, not much has happened on ground. But, it is a no-brainer that with hospitals trying to cover their own costs and working on a profit logic, they may try to raise money through other sources,” said a senior doctor working in a large private hospital in Mumbai.

“In the case of Maharashtra, cost capping has not been applied to personal protective equipment (PPE). There are also medications and tests not included in these rate caps and it is an open secret that hospitals make money through billing the costliest brands of such elements even in routine times. We might see inflation there going forward,” said the doctor.

Private hospitals previously came under fire for allegedly inflating the cost of PPEs used in treating COVID-19 and non-COVID patients. With insurance firms refusing to reimburse the cost of these PPEs, the burden has been falling on patients.

However, private hospitals have argued that the rates they charge for PPEs are justified and that patients are informed in advance about the charges.

A representation made by industry body FICCI on the costing of COVID-19 beds for the private sector estimated the cost of PPEs to run into around Rs 10,000 per patient per day.

According to the representation, evidence-based practice around the world indicates a consumption of 8-10 PPEs per day for treatment of a COVID patient in an intensive care unit (ICU). FICCI estimated each patient may have an average stay of 18-20 days.

While the family of a Delhi-based COVID patient had raised the issue with Max Healthcare billing Rs 70,000 bill for PPEs over a nine-day period, the hospital had said the overall consumption of PPEs during a 24-hour cycle is approximately nine PPEs per day per person in the ICU.

“The PPEs are charged at approximately Rs 1,200 per PPE per day and are in line with the costs incurred by the hospital in sourcing the PPEs,” stated the hospital, adding that this had been explained to the patient’s family during the time of admission.

“As per the government directive, hospital medical staff who are in direct contact with the patients are advised to use good quality PPE kits and masks, which are essential for the safety of the patients and the hospital’s medical professionals,” said a spokesperson for Fortis Healthcare, one of India’s largest private hospital chains.

“Where PPE is required in treatment, the cost of the actual PPE being used is charged. In ICUs or wards with multiple patients, the total cost of PPEs is divided by the number of patients in the ward. Also, to ensure minimal impact on the patient, PPE is being charged at much lower than the MRP,” the spokesperson said.

While some insurers had initially paid for PPE expenses for COVID and non-COVID treatment as an exception at the beginning of the pandemic, the practice of “overcharging and profiteering” by hospitals had become “glaring”, making it difficult for these costs to be covered, an official with a general insurance company said.

“Some hospitals are charging as high as Rs 1,200-1,400 for a PPE which generally is available for Rs 200-250. Patients must know that since the insurance policies don’t cover them, the cost of such expenses will have to be borne by them and they need to be aware of such overcharging practices by hospitals,” said the official, requesting anonymity.

Non-medical expenses, including disposables like gloves and PPEs, are usually not covered by insurance firms as per the Insurance Regulatory and Development Authority (Irdai) guidelines.

A top official with a leading general insurance company said that in the absence of standard protocol for consumables like PPEs during the pandemic even from the Indian Council of Medical Research, the firm is individually going through each case.

“In many cases, we have seen that the hospitals are overcharging. In the case of PPEs, we are analysing the billing in individual cases. If a patient is using PPE then we will approve, however if the doctor and medical staff are using it, it can’t be one PPE per patient and so we are critically evaluating its use before approving its payment,” the official said.

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