deponti (deponti) wrote,

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How we got out

This evening, the "main" doctor finally came and announced that the elevated levels of urea and creatinin in the blood test were indeed due only to the infection and the medication, and added, jovially, "I don't keep healthy patients in my hospital, you can go home".

When I went down to the reception to request them to get the discharge papers ready, the receptionist baldly said, "Go tomorrow morning."

"Why on earth should we stay overnight in the hosptial when the treatment has been finished and the patient is OK?" I asked...and slowly, the insurance racket was revealed.

When KM got admitted and we submitted his Medi-assist form, (this was the Cashless policy) the hospital put in a claim to the insurance company (New India Assurance) for an amount of Rs.12K, to cover the possible costs of ONE day of hospital stay.

It is the duty of the hospital to follow up with the insurance company and see that the claim is authorized. But it is usually NOT done by them at all. Having known of this, I started calling up the automatic system on the insurance company, and finally got a "partial" amount of 7K authorized. This would have covered the first day's bill.

However, since the doctor asked KM to stay back another day and have a scan and some blood tests done, obviously the amount exceeded the 7K. The hospital did not chase up the insurance company to authorize the full 12K today, and in my tiredness, I too forgot to chase it up. Hence, if we were to leave the hospital, the bill exceeded the insurance authorization amount by 2K, which we would have to pay by cash if we wanted to leave.

Instead of its being explained to us in this fashion, however, what we were told was, "Stay till tomorrow". This would result in time for the hospital to get the full amount authorized...but it would also allow the hospital to charge us, at least, for one more day's room rent, for a room that would probably lie fallow otherwise.

We resisted being told to stay over, and I had to talk to the doctor again, who finally said that since the urologist whom KM was supposed to meet wasn't turning up today, we could go home and come back to visit him the next day. At this point we were told that we would have to pay the extra 2K by cash...AFTER paying large premiums for the "cashless" mediclaim policy. We might have to later fight it out with the insurance company if we wanted the extra amount to be covered by them.

Since it was on insurance, the hospital had also ordered medicines rather plentifully, and several hundred rupees' worth of injectable drugs and Ringer's Lactate IV bottles lay unused. "Why bother with them, you are on insurance!" said our nurse. We returned the unused medicines to the medical shop, and asked that the amount be adjusted on our bill. We got a rigmarole about how the bill had not been made yet...if that was so, how did the hospital give us the total bill?

There was also the fact that by claiming insurance now, we would lose the "no claims" bonus for the next few years; so the calculation had to be made...if the loss on that was greater than the amount we were claiming now, it made sense to settle the bill out of pocket.

Insurance is SUCH an unethical racket, especially so in this country where there is hardly any accountability. I've taken the car for repairs and been asked, "Insurance or not?"...and the insurance quote would be 3 or 4 times the non-insurance one....

So, after paying large premiums for the "cashless" medical insurance, we wound up paying 25% of the bill by cash, and we do not even know if we will get that amount re-imbursed. What a swizz!

We did a wise thing by choosing a simple, small nursing home where food could be brought in by the patient or hes family, and medicines could be bought independently. In larger hospitals, we would be fleeced on food and medications, and on the room rent, too.

I am sure that in a large, "famous" hospital, the bill would have been at least 4 times the amount we had here.

We are actively considering stopping our medical insurance from the time it falls due.....
Tags: insurance, medical claims, practice, racket

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