Insurers question high costs of Covid treatment in private hospitals

CHENNAI/BENGALURU: When Sanjay Nagral, a surgeon, tweeted that a Covid-19 patient was billed Rs 12 lakh for treatment at a private hospital, he raised his eyebrows at officers. After all, how much insurance would the virus require?

With private hospitals now offering treatment, health insurance claims range from Rs 90,000 to Rs 6.5 lakh. A clamor for package fees is mounting to address bloated invoice concerns.

While hospitals are doing commendable work, we also see some cases of improvement in length of stay, antibiotic abuse and clustering of procedures, said Dr. S Prakash, MD, of Star Health. Star Health has resolved 41 claims to date with the highest amount of Rs 6.5 lakh.

Sources said the General Insurance Council (GIC) is seeking government intervention to define a treatment protocol, along with package fees, based on what insurers pay for claims. routine health insurance. “Without surgery, the protocol should be the same, unless there are other medical complications for the patient. You can't pass 300 gloves or a PPE suit to a patient in one day, ”said an industry source.

Another head of a life insurance company noted that health insurance rates are regulated but health care rates are not. He said that after years of dealing with hospitals, insurers have negotiated rates for some procedures with hospitals that are part of their network. In the event that (the claim) is from a non-network hospital, then, during the time of the reimbursement, we could partially reject the claim if we feel that the hospital was artificially inflating its fees, he said.

Hospitals say Covid-19 patients' approach to treatment is no different. “The medications and the treatment are similar to the ones we use for other respiratory diseases. Therefore, the largest item to be billed could be the room rent and the (PPE) used by the hospital staff caring for the patient, ”said Dr. Manish Rai, head of Manipal Group Hospitals. As for the use of a ventilator, that would be for very few patients. We don't have a large enough database in the Covid-19 case to say anything specific, he added.

Pandemic claims are classified into three categories: mild, moderate, and severe, based on infection levels. While mild cases have seen hospitalization for 5.5 days, moderate ones last 7 days and severe cases at least 11 days with a minimum stay of two days in the ICU.

It has also started receiving claims from Covid-19. The average claim size is Rs 5 lakh to Rs 6 lakh, said Sanjay Datta, head of underwriting, claims and reinsurance.

Since the government is already limiting rates for virus testing at Rs 4,500, insurers are seeking intervention to set package fees. These are the first days. We will move toward standardization as we go. We will discuss the matter with the government through the General Insurance Council (a grouping of nearly 50 general and health insurance companies), ”said an official from a medical insurance company.

Girija Kumar, president, feels that it is premature to talk about prices. “There are not enough cases to reach any conclusion in this regard. At Oriental, we have received only 3 complaints so far. Insurance claims are not an indicator of treatment costs for the approximately 2,000 Covid-19 patients currently in India, as health insurance penetration in India is poor, ”he says.