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Old 11th April 2010, 11:14   #16
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It is 5% of Non Medical Expenses viz room charges,doctor fees, medical reports and NOT on medicine.

It is pretty evident thay are doing it in well planned manner/with in legal bracket after consulting their legal dept! so they are not charging it on medicine. (Otherwise it will be case of selling medicine above MRP prices)
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Old 12th April 2010, 15:28   #17
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Quote:
Originally Posted by vivekiny2k View Post
Let me tell you guys something. Health insurance is a big scam. Indian entrepreneurs have learnt this business opportunity from USA and I won't be surprised if India falls into the same black hole that USA is in WRT health care.
+ 1 to that. Health insurance is going to push up costs unnecessarily.
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Old 12th April 2010, 15:37   #18
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It is the usual norm here that consumables like gloves syringis ect are not paid by the insurer, one of my team members wife had a delivery in KIMS Trivandrum, though our company provide both cash less inpatient and cash less out patient treatment he still had to pay close to 5k. To him he said he got world class facility so he does not care, but same thing happened to me, i was handed over a similar bill when i underwent an surgery in jan this year.

Pramod
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Old 13th April 2010, 15:05   #19
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Here is update:

Hospital is charging 5% as service charges on non medical expenses (Everything except medicine) for both mediclaim as well non-mediclaim customers.
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Old 13th April 2010, 15:22   #20
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This Mediclaim is a big messed up industry in our country. I believe some authority should take this up.
My present Insurence company is just rejecting the claim with all un-realistic reason... And in the same way if you hold a MedIns then the Hospital is charging you a hefty amount. And end of the day we are the suffer.
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Old 9th March 2011, 18:11   #21
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

In pune this is 10%. The biggest joke is hospital is asking how much cover do you have & accordingly they are making the bills. I asked them for stranded quotation for their procedures , which they refused to give :-(.

So it makes sense to not go for cashless & then get reimbursement, but the problem is if bill amount is big then you need to pay from your own pocket & the reimbursement takes more than 3 weeks to settle.

God only help India , with such kind of incidents we are taking the saddest part of US medical industry.
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Old 10th March 2011, 12:21   #22
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

As i recently experienced in the case of a cousin of mine, if you opt for cashless, 10.3% as service tax is additionally payable. The insurer paid to the full limit of say Rs 100, the amount adjusted against hospital bills was Rs 100 -10.30% = Rs 89.70.

If you opt for Reimbursement, there is always an element of uncertainity/ risk on the amount that the insurer will reimburse. The time taken for reimbursement is anything between 1-3 months. However, no 10.3% service tax is levied on reimbursement.
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Old 10th March 2011, 13:22   #23
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Unhappy Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Idea,

Can you please clarify for what reason is the 5% charge being levied. Is it for something which is not covered under the cashless scheme? If yes then the validity of the claim needs to be verified. If not then this is daylight robbery. You need to talk firmly to the hospital and contact the Insurance co about this charge.

Some where in the earlier post I read that upon admission an estimate is given by the hospital and balance of the claim is payable after treatment completion. I was under the impression that upon admission all one needs to do is contact the Insurance co and let them take over the charges part in discussion with the hospital. Atleast thats what my Insurance co told me. Why would the Insured spend time raking the brains when they already are the troubled ones.
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Old 10th March 2011, 13:35   #24
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Quote:
Originally Posted by ghodlur View Post
I was under the impression that upon admission all one needs to do is contact the Insurance co and let them take over the charges part in discussion with the hospital.
That not how it works (even though insurance company claims that). For unplanned admissions, this is the usual procedure:

1. You take patient to hospital
2. Hospital initiates insurance process, they would have a "TPA Cell/TPA Team" to take care of this.
3. You pay a deposit to hospital. It depends on "Grade" of surgery and type of room. Usually 50,000 to 2,00,000 in Reliance/Lilavati and such. Credit card works.
4. Insurance company authorizes the procedure/surgery. If not then you need to pay full amount.
5. Hospital would refund the deposit at the time of discharge.
6. Hospital would hold some amount of discharge (5 - 15k) that would be paid only after hospital gets money from Insurance. usually some amount would not be paid by insurance (E.g. toiletries / food for attendant etc).

For planned:

1. Get estimates from Hospital
2. Give insurance details to hospital
3. Once insurance gives approval Hospital would ask for patient to be admitted.
4. 5 - 15k to be paid to cover things that would not be paid by Insurance
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Old 10th March 2011, 13:52   #25
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Question Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

@Netfreakbombay,

I beg to differ on your comments. I have attached the Apollo Munich claim process for reference purpose.

http://www.apollomunichinsurance.com...-Procedure.pdf

The PDF doc does not talk about any deposit to be given during admission. Also for planned admission no estimate is needed from the hospital, only prior authorization from the Insurance co/TPA is needed.
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Old 10th March 2011, 13:59   #26
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

I am sure this is another tactic to milk the customer. Just threaten the hospital folks that you are going to inform the health insurance company about such charges. I have seen this trick works as there is a threat of being blacklisted by medical insurance company.
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Old 10th March 2011, 14:03   #27
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

That document is from Insurance company's point of view and is correct from that P.O.V.

But as a patient/attendant you have to deal with hospital too. This deposit is taken by hospital (not by Insurance company).

to confirm, you can call admission desk of any major hospital.

A related new article:

How hospitals, insurers are cashing in on cashless cover - Mumbai - DNA

Quote:
To check if this indeed was the case, DNA visited hospitals in Mumbai and Navi Mumbai. The accounts counter of these hospitals — Lakshadweep Hospital, MGM and Bombay Hospital — where the bills are to be settled displayed a list of TPAs and the deposit that the customer has to pay to avail the cashless facility. This ranges between 20-25% in most cases.
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Old 10th March 2011, 14:16   #28
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Quote:
Originally Posted by tj123 View Post
I am sure this is another tactic to milk the customer. Just threaten the hospital folks that you are going to inform the health insurance company about such charges. I have seen this trick works as there is a threat of being blacklisted by medical insurance company.
The famous Manipal Hospital belonging to the Manipal Group was blacklisted by the third party administrator of my company with regards to cashless hospitalization for consistently inflating bills.
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Old 10th March 2011, 14:49   #29
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Quote:
Originally Posted by ghodlur View Post
Idea,

Can you please clarify for what reason is the 5% charge being levied. Is it for something which is not covered under the cashless scheme?
Said hospital call it service charge (Not service Tax). They have displaced the same in their accounts as well as admission section.

Hospital Name: Deenanath Mangeshkar, Pune.
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Old 19th March 2011, 20:34   #30
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Default Re: Cashless Mediclaim : Hospital Asking for 5% Extra. Is it Justified?

Quote:
Originally Posted by idea View Post
Said hospital call it service charge (Not service Tax). They have displaced the same in their accounts as well as admission section.

Hospital Name: Deenanath Mangeshkar, Pune.
There are other hospitals also doing this in pune o & P , jahangir etc etc
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