No advance if patient has cashless cover: Pvt hosps

Kolkata: Private hospitals in Kolkata have decided not to demand advance deposits from patients with cashless insurance — toeing IRDA’s line — but said they would continue to charge an advance of up to Rs 50,000 from the rest, including emergency Covid patients.
The hospitals, however, maintained that they would be flexible about the time limit of 12 hours for the payment, set by the West Bengal Clinical Establishments Regulatory Commission (WBCERC), and were ready to extend it.
On Monday, leading health insurers had made it clear that hospitals in their network should not ask for pre-admission deposit amounts from patients with cashless health insurance policies. The clarification came two days after WBCERC allowed hospitals to charge an advance of Rs 50,000 or 20% of the estimated treatment cost (whichever was lower) at the time of admission.
Tuesday’s decision comes as a climbdown for private hospitals, and a significant relief for patients, many of whom were finding it difficult to arrange for cash on short notice.
The hospitals had earlier said they had been insisting on the advance payments because many patients later refused to pay the “inadmissible” part of the bill. On Tuesday, some city hospitals said they would seek an undertaking from cashless patients that they would pay this part. This was decided at a meeting of hospital chiefs under the aegis of the Association of Hospitals of Eastern India (AHEI) on Tuesday.
While a formal meeting of AHEI is due later this week, member-hospitals said the advance was necessary to realize bills that were often remaining unpaid. “Most hospitals will be continuing with their existing practice of charging an advance, but will now make sure it doesn’t cross Rs 50,000, and that cashless patients are not charged,” said AHEI president Rupak Barua. “The rest will have to pay an advance but it will not be an arbitrary or exorbitant amount. Also, we shall allow patient parties adequate time to arrange for the advance and there will be no pressure on them.” He added that hospitals would be urged to be “flexible and lenient” about an advance from patients without cashless cover.
Third-party administrators and insurance companies welcomed the hospitals’ decision. They, however, said they would keep a strict watch, over the next week or so, whether hospitals really keep their promise. Jyotirmay Kunu of Heritage TPA and C Bera of Raksha TPA said the hospitals’ decision was undoubtedly good. Sophia Singh, GM (health), National Insurance, said they would closely keep watch for the next few weeks. “This decision was the need of the hour. But we have to see whether they are sticking to it,” she added.
In recent weeks, several Covid patients’ families alleged that they had been forced to deposit an advance in the range of Rs 4-5 lakh, despite an insurance cover. Hospitals, on the other hand, have claimed that patients on insurance — including those with cashless cover — often refuse to pay the part of the bill which is deemed inadmissible in claims.
Alok Roy, chairperson, Medica Superspecialty Hospital, said the development would help a large number of emergency Covid patients who often struggle to arrange for money for admission. “While we are flexible about advance payments and don’t insist on it, we shall now desist from asking for it from cashless patients. But the latter will have to sign an undertaking saying they would pay the amount that’s not approved by the insurance company. This amount often remains unpaid,” said Roy.
Peerless Hospital has already started to seek an undertaking from cashless patients, but they are not asked for an advance. “While we may ask for an advance from the rest, we are not keen on charging advances since they can’t guarantee a full payment. We often come across patient parties who readily pay an advance but falter at the time of making the full payment. So, we shall stick to our policy of not charging an advance from patients who have some insurance cover,” said Peerless Hospital CEO Sudipto Mitra.
Another private hospital said it, too, would seek an undertaking from cashless patients. “They must assure us that they will pay the inadmissible part, since it will always be there. From the rest, we will seek an advance and profile them discreetly to gauge their ability to pay,” said the hospital chief.