No Covid, yet Rs 3.71 lakh hospital bill: Gujarat man’s insurance paid only Rs 1.78 lakh, deducting Rs 1.64 lakh; Then court delivered justice
The Surat Consumer Disputes Redressal Commission (CDRC) also awarded Rs 10,000 as compensation for mental harassment and litigation expenses, holding the hospital and the treating doctor responsible for the controversial charges.
How Did the Dispute Start?
The case was filed by a 58-year-old Surat resident who purchased a medical indemnity policy worth Rs 7 lakh. The policy was valid from August 2019 to August 2020.
During the Covid-19 outbreak, the man was admitted to a private hospital in Surat’s Piplod area between July 22 and July 29, 2020, for medical treatment.
Following his discharge, the hospital issued a bill of Rs 3.71 lakh. The patient then submitted the bill to the insurance company for reimbursement under the medical indemnity policy.
Why Did Insurance Company Drop Rs 1.64 Lakh?
While processing the claim, the insurance company approved only Rs 1.78 lakh and denied reimbursement of Rs 1.64 lakh.
The patient then approached the consumer forum, naming the insurance company, the third-party administrator (TPA), the hospital, and the treating doctor as parties to the complaint. During the trial, the lawyer representing the insurance company argued that the patient was diagnosed with “viral pneumonia, Covid-negative”.
Despite this diagnosis, the hospital allegedly billed him under the Covid-19 treatment package prescribed by the Surat Municipal Corporation (SMC).
Consumer Commission Finds Flaw in Hospital Billing
After reviewing the documents and listening to all parties, the commission noted that the patient was not diagnosed with Covid-19.
The forum observed that the hospital bill specifically states that the fees are collected based on SMC’s Covid-19 package prices.
The commission also stated that neither the hospital nor the doctor could satisfactorily explain why Covid treatment package rates were applied to a patient who tested negative for the virus.
As a result, the forum concluded that the hospital and the doctor were responsible for the amount deducted from the insurance claim.
It was decided to repay the hospital and doctor with interest
The commission directed the hospital and the doctor to jointly refund Rs 1.64 lakh to the complainant.
In addition, annual interest of 8 percent will be applied to the amount starting from July 31, 2021, the date of the complaint.
The forum also awarded compensation of Rs 10,000 for mental and physical harassment along with litigation costs.
Important Consumer Rights Decision
The decision highlights the importance of accurate medical billing and accountability in healthcare.
The commission’s decision makes clear that hospitals must justify treatment packages and fees charged to patients, especially where such fees directly affect insurance reimbursements.
The case also serves as a reminder that patients have the right to dispute disputed medical bills and seek compensation through consumer forums if they believe they have been unfairly charged.
Inputs from TOI
