Max Healthcare — excess amount charged in covid-19 treatment of my mother - mrs. mukta jain (ip no 393677, uhid ehpg [protected]) amounting to rs. 1, 80, 548/-

Address:

108A, Indraprastha Extention, Patparganj, New Delhi - 110092

Dear sir,
My mother mrs. Mukta jain (Ip no – 393677, uhid – ehpg [protected]) was admitted to max hospital - patparganj on 16th june 2020, 9:00 p. M. Having the symptoms of covid -19. She was in a very critical conditions and was taken into emergency and her treatment started.
Now the story begins:
A) i was having a family floater policy from national insurance amounting to rs. 5 lakhs/-. Details i had submitted at the time of admission.
B) delhi government passed the rule on 20th june 2020 and put the capping on the private hospitals for the covid-19 treatment.
C) my mother was discharged from the hospital on 10th july 2020 after 25 days of treatment including icu stay and plasma therapy as well.
D) at the time of discharge, i came to know that my billing was not happening as per the delhi government rate but were done as per the hospital own rates.
E) during the treatment my tpa was approving the amount based on the interim bill send by the hospital to them. Last approved amount by tpa was rs. 4, 07, 000/-. Now comes the main part, the discharge story.
F) at the time of discharge, on 10th july 2020, i was waiting for the tpa final approval unknown of the fact that my billing was done as per hospital rate. I suddenly got a call from billing head of max patparganj that “sir, tpa has denied your whole claim of rs. 4, 07, 000/-. Please come and meet us”.
G) i immediately went to meet the billing head of max patparganj. He explained me that “sir, your claim has been rejected by tpa fully and now you have to pay the full amount to us”. I was shocked, i told him how it can happen, i am getting all the messages of approval and all and last approval was rs. 4, 07, 000/-. How can a tpa reject the whole claim. He then told me that sir tpa was saying that we are overcharging the rates and not following delhi government rate circular. I was again shocked. I told the billing head, “sir, if you are overcharging the patient and not following the government orders than the tpa is correct in rejecting the claim”. You are doing the wrong thing and unnecessary blaming the tpa for that.
H) after having the communication over half an hour, i ask him very politely that sir what is the main problem, what is the query tpa has raised? Tell me that. Then the billing head responded that “sir tpa has requested us the revised bill as per government norms, which we can’t submit to them as we are protesting against the order. All private hospitals are protesting. We will be following our rates in insurance cases and will follow government rates in case of cash patients.
I) then after a long discussion i told him very clearly. Sir, you first prepare my bill as per government norms and give me in writing that you have prepared this bill as per delhi government norms and this bill be eligible for reimbursement at insurance company, only then i will pay you the amount.
J) after some time, billing head called me to his room and showed me the bill as per government rates. I was shocked again.
My initial bill that hospital is charging was rs. 8, 34, 115/-
My bill as per delhi government rates was rs. 6, 53, 567/-
Overcharged amount – rs. 1, 80, 548/-
K) i asked the billing head a very simple question, sir how can a same treatment will cost two different amounts whether it’s an insurance case of a cash patient. How will your billing be changed in these 2 cases as the treatment is the same? He was unable to explain me the reason for that. The only thing he was saying is that, this is as per hospital policy, we can’t help you in that.
L) from the above i understood that hospital is charging an extra amount of rs. 1, 80, 548/- from me.in the meantime, when all these discussions were happening, hospital got an approval from tpa amounting to rs. 4, 41, 277/-.
M) i then asked the billing head that my amount as per government rate is rs. 6, 53, 567/- which you have only calculated 1 hour back less the tpa approval amount i. E. Rs. 4, 41, 277/-. Now the differential i am eligible to pay.
N) you will be shocked what the billing head told me. He told me that this approval you have got because o[censored]s and we will be charging as per our hospital rates only i. E. You have to pay to the hospital as per rs. 8, 34, 115/- only.
O) after that also i requested him a lot that sir, if you have sent the bills to tpa as per government rate then also i would have got this much approval as per my policy but he didn’t listen to me and said that we can’t help you in this. This is as per our hospital senior management instructions.
P) at last since its was too late in night and i have to discharge my mother and make other necessary arrangements as well as she was discharged on oxygen. I paid to the hospital the differential amount as per their billing i. E. Rs. 8, 34, 115/-
By reading the above instance, now you can judge how these hospitals are taking advantage of the common people and not following the government orders.
Since last 2 months i have not raised any concerned as my mother health was not good at home also and i was busy in taking care of her.
But now i request the competent authority of hospital to take the quick action in my case and give me a refund amounting to rs. 1, 80, 548/- failing which i will file a case against the hospital and all persons involved in this.
For your reference i am attaching both the bill copies i. E. Bill as per hospital rates (Rs. 8, 34, 115/-) bases which i have settled the amount and bill as per government order rates (Rs. 6, 53, 567/-).
I have no objection with the hospital or the doctors other than the above issue.
Lastly, i request again to refund me back the excess amount you have charged i. E. Rs. 1, 80, 548/-.