However, the Tamil Nadu unit of the Indian Medical Association has asked the government to review the COVID-19 price cap saying it is not feasible for hospitals to maintain it.
The first sign was a high fever. And when the coronavirus test results came in two days later, Chennai-based Saminathan * realized he had COVID-19. However, the interpretation was ‘moderately positive’, so his family decided to keep him in home isolation. But a day later, Saminathan experienced shortness of breath, prompting his son Krishnan * to take him to a GP. The doctor told the family that Saminathan’s oxygen saturation level was low and he needed hospitalization. After three referrals, the family got a bed with oxygen support at a private hospital in Kilpauk. However, Krishnan alleges that the hospital used his emergency situation to maximize its profits.
The hospital kept Saminathan for nine days and the family ended up paying a total of Rs 4.14 lakh. This, Krishnan says, compared to the original bill of around Rs 2.7 lakh. “The hospital refused to follow the limit set by the government on COVID-19 treatment charges. They also received an advance of Rs 1.5 lakh which was not returned, ”he alleges. Krishnan accuses the hospital of not even submitting the invoice for some transactions.
Krishnan is not the only one experiencing this. Months after the pandemic, there are multiple accusations against private hospitals in Tamil Nadu for defrauding money from coronavirus patients and their families. This, despite the Tamil Nadu government limiting COVID-19 treatment in private hospitals on June 6. The health department arranged two slabs for hospitals classified as A1 and A2, and A3 and A4, depending on the number of beds and doctors available. A grade A1 and A2 hospital may charge Rs 7,500 per day from asymptomatic or mildly symptomatic COVID-19 patients, while Grade A3 and A4 hospitals may charge Rs 5,000 per day. The maximum charge per intensive care unit (ICU) for private hospitals has been set at 15,000 rupees per day.
The private hospital where Saminathan was receiving treatment belongs to category A3-A4, says Krishnan. “On October 3, the hospital told us to immediately pay an advance of 1.50,000 rupees for admitting my father. When I said I had insurance, I was told that since it was midnight, there were no insurance agents to help with transactions at that time. It was a huge amount, but I ended up paying because I had no other choice. I still have proof of the transaction, “he says.
Krishnan’s father was in the ICU for a day and then he was transferred to the normal ward. Everything seemed fine for the first few days, but the hospital reportedly started delaying the insurance claim, even four days after Saminathan was admitted. “Only then did the hospital inform me that the insurance company will not pay the entire claim and only a partial claim. It puzzled me, as I knew they had a scheme in which it was possible to claim full insurance. When I started to question them, the he hospital said it will not be able to produce a bill for the exact charges for the room and ICU. “
“They told me they charge 40,000 rupees per day for ICU and 30,000 rupees as room charge, but they will mention only 15,000 rupees for ICU and 5,000 rupees as room charge on the bill, excluding treatment,” he alleges.
Frustrated, Krishnan decided to transfer Saminathan back home and the hospital also agreed to release him on the ninth day after much insistence. “I was given a bill for Rs 2.76 lakhs and my insurance was sanctioned for Rs 2.53 lakhs of this amount. To my surprise, the hospital told me that my advance amount would not be returned, which made the bill total would be 4.14 lakh rupees. The hospital refused to give me a bill for the full amount and did not return the advance either, “says Krishnan.
Mediation by health department
While state health department officials admit to receiving such complaints about overcharges from private hospitals, they say they are trying to mediate between the aggrieved parties rather than revoking the hospital’s license at this time.
A senior health department official tells TNM: “We have hospitals settle the additional amount charged, and thus, we have solved 18 cases in Tamil Nadu,” he says. “However, if a hospital constantly overcharges or if there are flaws in the procedures or if it does not report deaths, then we revoke the license. But generally, we try to mediate between families and hospitals. “
“The problem of overload can be solved immediately: we calculate the amount of the invoice and repair it. If this has happened in Chennai, we can solve it in a day or two, ”says the official.
In Tamil Nadu, actions have been taken against nine institutions; three institutions have lost their licenses due to these problems.
Indian Medical Association seeks maximum price review
On the other hand, there is the argument that the maximum price set is not feasible for private hospitals to maintain. The Tamil Nadu unit of the Indian Medical Association accused the government of failing to listen to stakeholders when setting fees for the treatment of COVID-19.
IMA State President CN Raja, who previously supported the government’s move to limit the price of COVID-19 treatment in private hospitals, says: “So far, many hospitals are buying Remdesivir and other drugs needed for COVID-19 treatment. at a higher cost. Can the government give a white paper on the cost of treating a patient in a public hospital? They cannot, so it is unfair to set 15,000 rupees a day for ICU treatment without clarifying whether this includes medical expenses or not, ”he says.
“When the problem of overloading in government hospitals started, we worked on pricing and submitted a proposal to the government. However, the government did not respond and a few days later they issued a government order fixing the rates. Now, there are complaints that hospitals charge more, but the rates need to be revised. The government did not set the correct amount by asking interested parties, ”he adds.
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