Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

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Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Need some info.

Recently my family member is admitted to ICU in a reputed hospital due to medical emergency. Hospital is in cashless facility of my mediclaim

facility. It means i dont have to pay anything as long as my expenses are not beyond my sum insured.

However, hospital management is asking for 5% extra on total bill under head of service charges !! This is totally new to me and i have never heard of it.

I have used cashless mediclaim facility quite few times earlier and no hospital has asked me for such charges.

Seeking opinion. Would also appreciate legal perspective if possible.

PS: Its not about money or 5%, but i surely feel it is not legitimate to ask for this.



Here is example:

Suppose hospital bill is 50000/-

Hospital is syaing , mediclaim will pay all 50000/- but as per hospitals policy, i need to pay hospital over and above of this 50000/- and that amount is 5% (under name of service charge?) of total bill i'e 2500/-

So hospital will get 50000/- (Actual bill- will be given by mediclaim) + 2500 (from patient.): Total 52500/-



This is also shocking that total bill also covers medicines purchased at MRP so if they are taking 5% on that , they are actually selling medicines above MRP rates.
 
there are a lot of hospitals which charge ranging from 5 % to 20 % as additional heads like service charge / facility charge / or some other fancy names.

this has increased after the cashless facility has started as some insurance companies deduct some percentage of final bill without any reason, these charges act as cover for those charges.

there is nothing new / suspicious to it.

as I am a doctor i know how this hurts patients, thats the basic reason why i dont take may patients to corporate hospitals, as I get much less while patients get charged like bomb.

ps : this acts like service charges at some restaurants, nothing illegal about it.

ps2: i have heard, though dont know for sure, some hospitals ask you to pay upto 30% of your total bill in advance against any rejection or deduction of cashless claims. This is to be settled after the cashless claim is settled.
 
medpal said:
there are a lot of hospitals which charge ranging from 5 % to 20 % as additional heads like service charge / facility charge / or some other fancy names.

this has increased after the cashless facility has started as some insurance companies deduct some percentage of final bill without any reason, these charges act as cover for those charges.

there is nothing new / suspicious to it.

as I am a doctor i know how this hurts patients, thats the basic reason why i dont take may patients to corporate hospitals, as I get much less while patients get charged like bomb.

ps : this acts like service charges at some restaurants, nothing illegal about it.

ps2: i have heard, though dont know for sure, some hospitals ask you to pay upto 30% of your total bill in advance against any rejection or deduction of cashless claims. This is to be settled after the cashless claim is settled.
Click to expand...

Hospital around me had a notice if u have a cashless mediclaim please deposit 5k before admitting
 
Asking additional 5% is certainly illegal on the face of it. Ask them to show you the documents on the basis of which they are demanding you this additional charge. Even if they claim as the amount which the Insurance companies refuse to pay then ask them to show you the *actual* deductions from the company.
 
i have also taken cashless facility numerous, but never i have i ever paid these kind of charges..

start shouting, say u will not go there again.

the expenses like food, admin charges are not covered.. infact the cashless facility used to always give 100% before, now however the hospitals have gotten greedy..

they charged 20,000 just to put 3 bottles of drips to my mom.. the insurance co obviously rejected it and paid only 7k..

i say go to admin and make a big fuss!

i have also taken cashless facility numerous, but never i have i ever paid these kind of charges..
start shouting, say u will not go there again.

the expenses like food, admin charges are not covered.. infact the cashless facility used to always give 100% before, now however the hospitals have gotten greedy..

they charged 20,000 just to put 3 bottles of drips to my mom.. the insurance co obviously rejected it and paid only 7k..
i say go to admin and make a big fuss!
 
This is normal and not at all illegal.

5% is very less. If you are admitted to a higher class room, you can be charged 20-30%.

MRP items are included in the bill, but Service charge is not charged on those items. Look carefully, if they are, contact the hospital billing dept.. They will reverse it.
 
from a legal point of view this is questionable . but there are aspects on both sides. still considering the hospital bills these days 5- 10% of the total bill is still a safe thing
 
extra charging doesn't makes any sense even if it's 1%.

When insurance company says everything will covered than why to pay extra, only if there is fine print in your policy that mentions about this kind of surcharge.

Raise this to your Health Insurance provider and ask for proper settlement.
 
I had just undergone surgery through the cashless medical insurance scheme. Everything was approved by the insurance company. But the hospital asked me to pay a deposit of 2500 rupees which ill get back after the insurance company actually pays the hospital back..... so inturn I will be getting that deposit back from the hospital.... didnt have to shell out anything extra from my pocket....
 
Actually its part of business model for hospitals now these days

Thats the reason government have come up with limit model where if u have say 1 lakh cashless insurance not more than 1 or 2% of the amount will be paid for bed charges and so on for other room charges etc

Since people used to make rounds of expensive hospital even for small problem where u dont need to get admitted..Now thats government side

My sister was recommended for jaundice once and once she said she had cashless facility to the tune of 3 lakh family floater suddenly the hospital started tons of expensive medicines and also we found the nurses used to steal our medicine and than claiming its the one provided by hospitals mostly syringes

Also they charged us for say 7 days whereas my sister was admitted for 4 days...after she made a fuss they were not ready to refund but stated we will provide u free medical checkup on its place...Plus they were ready to inflate bill stating that since 21k is the expense we will make it 27k and ull get the same but u also pay the same here of-course we refused as we found it quite illegal plus it reduces our family cover for that period and why should they make a business from us.

A humble note please do make a list of hospitals if someone in your society is admitted and do check their experience and all.It will certainly help in future
 
This is very sad, wats more sad is people justifying it..if a hospital doesnt get along with a mediclaim company they should get off their list of available hospitals!
Call your insurance agency and tell them abt this, they will surely talk to the management and sort things out,
Also write an article to news paper editors and all..sounds stupid, but my neighbour once did and got an apology from a famous hospital and refund of excess charges!
 
MAGNeT said:
Actually its part of business model for hospitals now these days

Thats the reason government have come up with limit model where if u have say 1 lakh cashless insurance not more than 1 or 2% of the amount will be paid for bed charges and so on for other room charges etc
Since people used to make rounds of expensive hospital even for small problem where u dont need to get admitted..Now thats government side

My sister was recommended for jaundice once and once she said she had cahsless facility to the tune of 3 lakh family floater suddenly the hospital started tons of expensive medicines and also we found the nurses used to stock our medicine and than claiming its the one provided by hospitals mostly syringes

Also they charged us for say 7 days whereas my sister was admitted for 4 days...after she made a fuss they were not ready to refund but stated we will provide u free medical checkup on its place...Plus they were ready to inflate bill stating that since 21k is the expense we will make it 27k and ull get the same but u also pay the same here ofcourse we refused as we found it quite illegal plus it reduces our family cover for that period and why should they make a business from us.

A humble note please do make a list of hospitals if someone in your society is admitted and do check their experience and all.It will certainly help in future
Click to expand...

This is very horrible on part of Hospitals.

Specially staff posted in ICUs have been seen stealing medicines from patients prescription and selling off to medical stores (this is rampant in cases of insurance paid or company paid corporate patients) :mad:

The insurance companies are keeping a list of black listed hospitals and doctors on their websites, and its always safer to call them on their 24 hour helpline and get to know which hospital in your city is blacklisted.

But all these goes for a toss in case of emergencies when actually we need our cover of mediclaim as the most.
What you need to know about your Mediclaim :

1. Check the fine prints clearly, also do not hide any preexisting diseases, which you or your family members are suffering from at the time of initiating coverage.

2. Its always better though costly to go for Individual separate marked amount of coverage in family policy, do not go for Floater coverage.

3. Read / Ask about which diseases will be covered from how much duration of policies (as per new regulations cataract, tonsil, appendix, hysterectomy, Slip disk problems, and some more surgeries are covered only after 2 full years of completion that means you paid 3 premiums and 25 months of policy).

4. Never ever tell doctor to overcharge so that you can cover incidental expenses, and also never entertain such request from doctors.

5. if you are paying for some implants / operative consumables (like plates and screwes for orthopedic surgery or lens in case of cataract suregery) always insist on barcoded sticker on discharge card or vat paid bill mentioning your name.

6. Now a days companies are limiting your indoor bed charges to 1% to 2% of your total coverage so you get admitted to the room according to your coverage, otherwise you may end up paying from your pockets even though having mediclaim.

7. Companies have limited surgeons charges for many daycare surgeries to 30% to 40% of total coverage (os if you get operated for tonsill, appendix, cataract, or some other day care surgery as per your policy) you will get fixed sum irrespective of your coverage or limited reimbursement.

8. Majority of corporate hospitals have facility to know daily billed amount, so if your stay is longer do check about daily billing so that you can raise alarm at the earliest level.

9. When you are given big prescription then make sure to check each and every item yourself and if possible keep custody of costly injection with the person who is staying with patient 24 hours.

Hope it helped.

Do ask for more clarifications.
 
Hospital gives only the direct medical costs for cashless mediclaim. For all other items: food, non medical consumables etc, you ARE expected to clear it yourself. This is due to the mediclaim policies which clearly state this.

Also hospitals have started asking for amounts from 10-30% as deposit to be paid even in case of mediclaim policy, which gets refunded by cheque after 2 months. This is to give them some security in case mediclaim dos not cover the full bill, or as in some cases does not go through or is a fraudulent claim.
 
Might be for non medical expenses not covered by insurance. I fell sick last year and in three days the bill was 49k. Insurance paid around 46k and I had to pay the rest.
 
Here is update:

Hospital is charging 5% as service charges on non medical expenses for both mediclaim as well non-mediclaim customers.
 
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