Consumer panel asks hospital to pay Rs1.2 lakh to elderly Mohali man for inflating Covid bill

Aggarwal said that after the cashless permission was denied by Raksha Health Insurance, due to wrong information given by the hospital, and later the reimbursement was done by the insurance company due to his personal efforts.

Aggarwal also alleged that there are many types of extraneous charges in the bill, like alpha bed, PPE kits, which are wrong, and the charges of Rs 6,620 towards CT contrast was wrongly mentioned in the bill as the same was not done.

The hospital, in its reply, stated that the total bill amount was Rs 762,445, out of which Rs 44,108 was discounted and an amount of Rs 606,486 was approved by insurance company and the balance amount of Rs 1,11,851 was paid by the patient.

Max Super Speciality claimed that the bill was raised as per the hospital tariff and according to the memorandum of understanding between the insurance company and hospital. It also pleaded that the hospital bill and treatment record shows the visits and diet chart which was followed under the supervision of a professional dietician. It is further pleaded that the physiotherapy was done as per regular medical treatment of patient, and there are no excessive charges charged by the hospital.

The Oriental Insurance Company, in its reply, submitted that its third party administrator, Raksha Health Insurance, has already processed the claim and released the payable amount, and that the coverage is limited to the extent of the amount as mentioned in the Schedule of Policy of Insurance and nothing more has been found payable by the competent authority, further denying other allegations made by the complainant and prayed that the complaint be dismissed.

The Commission on hearing the matter held that the claim of the complainant is that the hospital has wrongly billed him for dietician visit who allegedly advised him milk at night whereas he is a patient of ulcerative Colitis, for visit of physiotherapist twice a day whereas no physiotherapy was done, and illegal charges for the use of 230 surgical gloves among other equipment.

“The advice of the dietician to take milk at night to the patient/ consumer, who is suffering from ulcerative colitis is a wrong advice which could lead to serious consequences on the health of the patient/ consumer, which is a clear cut negligence on the part of the dietician and amounts to deficiency in service,” the commission noted.

“Further the hospital failed to lead any cogent and convincing documentary evidence to justify the said charges billed from the complainant. Therefore, it is held that the Max Super Speciality Hospital, Mohali has illegally exaggerated the medical bill of the complainant by adding wrong charges for the services, which were never provided to the complainant, and this (behaviour) amounts to deficiency in service as well as adoption of unfair trade practice on the parts of the hospital,” held the commission.

It directed Max Super Speciality Hospital to compensate the complainant by paying a lump sum amount of Rs 1,20,000 for “causing loss, harassment and mental agony due to its deficient services” as well as “indulgence into unfair trade practice”, which also includes litigation expenses.