Bigger city hospitals bill 20% ‘service charge’

Though medical insurance policy holders shell out 5.4% extra to avail cashless benefit, scores of patients are being refused the facility on various grounds.

Many policy holders have had to arrange for money as the hospitals they chose did not feature on the list of preferred provider network (PPN), a programme launched by insurance companies on July 1.

Andheri resident Parmeshwari Agarwal, 65, was detected with breast cancer last month and the doctors at Bombay Hospital advised immediate surgery. Agarwal’s son Manoj applied for cashless mediclaim to Raksha TPA but was refused because the hospital was not on the PPN list. “I sold my mother’s jewellery to pay the Rs1.11 lakh required for the surgery,” said Manoj, who pays an annual premium of Rs10,000.

Moreover, bigger hospitals charge 20%extra on the cashless amount, which is not reimbursed by the insurance companies, as ‘handling charges’. “There is no justification for this charge and therefore the insurance companies decided against reimbursing this amount,” said a senior insurance consultant.

According to Col Manesh Masand, president of Association of Hospitals (AOH), “Surcharge is an internal matter of a hospital and it covers overhead charges like the electricity, water, staff salary, etc.” The insurance companies, however, question this stand as the hospitals apply surcharge only on the cashless claims and not on reimbursement claims.

Interestingly, only 2% of the Indian population has a medical insurance cover, while the figure in Mumbai is about 17%.