No advance if patient has cashless cover: Kolkata private hospitals – Times of India

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.
‘Most hospitals will continue with their existing practice’
While a meeting of AHEI is due later this week, hospitals said the advance was necessary to realize bills. “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.”
TPAs and insurance companies welcomed the hospitals’ decision. They, however, said they would keep a strict watch. Jyotirmay Kunu of Heritage TPA and C Bera of Raksha TPA said the hospitals’ decision was good. Sophia Singh, GM (health), National Insurance, said: “This decision was needed. But we have to see whether they are sticking to it.”
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.
Medica chairperson Alok Roy said the development would emergency Covid patients who often struggle to arrange for money. “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,” said Roy.
Peerless Hospital has already started to seek an undertaking from cashless patients, but they are not asked for an advance. “ 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. “They must assure us that they will pay the inadmissible part. From the rest, we will seek an advance and profile them discreetly,” said the hospital chief.