Covid-19 patients with medical insurance eligible for discounts

Private hospitals to offer at least 10 per cent discount on MRP of medicines

Subhajoy Roy   |   TT   |   Calcutta   |    10.12.20  :  A Covid-19 patient with medical insurance will be eligible for discounts on medicines and consumables if the treatment cost turns out to be more than what the insurance firm has paid, the state clinical establishment regulatory commission said on Wednesday.

The commission had in August asked private hospitals to offer at least 10 per cent discount on the maximum retail price of medicines and at least 20 per cent discount on that of consumables to Covid19 patients.  

Retired judge Ashim Banerjee, the chairperson of the commission, made the observations while asking Medica Superspecialty Hospital to offer a discount of Rs 1.5 lakh to the family of a patient who died at the hospital on September 3.

Banerjee said the hospital had submitted that the patient was not eligible for the discount because she had medical insurance.

“But we said that you have to offer the discount since the patient party had to pay the excess amount, which was not paid by the insurance company,” Banerjee told a news conference on Wednesday.  

The family of a 61-year-old woman who was admitted to the hospital with Covid19 and other ailments complained to the commission that the hospital had overcharged them. The patient was in the hospital for a month, of which 25 days were in the ICU, till she passed away on September 3.

The family was billed Rs 25.87 lakh.

“When we examined the bill we found that the hospital did not offer any discount on medicines and consumables,” Banerjee said.

“The hospital said the patient had medical insurance, so they did not offer any discount. But we said the medical insurers paid only Rs 5 lakh of the total bill. The patient party had to pay the rest. In such a situation, when the patient party has to bear the amount not paid by the insurance company, hospitals have to give a discount on medicines and consumables, according to the commission’s advisory,” he said.

After calculating the discount that should have been offered, the commission asked the hospital to offer a discount of Rs 1.5 lakh to the patient’s family. 

The commission on Wednesday also asked Belle Vue Clinic to return Rs 90,000 to a patient, of which Rs 54,000 pertained to the price of Meropenem, an antibiotic that is being used to treat Covid-19 patients. 

Banerjee said the hospital had violated the commission’s advisory to private hospitals to supply cheaper antibiotics to patients from its pharmacy unless the doctor prescribed a drug of a particular brand. 

“The price of Meropenem ranges between Rs 650 and Rs 3,500. The hospital gave the patient Meropenem 31 times at the cost of Rs 3,000 and three times at the cost of Rs 1,250. We told the hospital they have to charge Rs 1,250 for all the times the patient was given Meropenem. The discount on Meropenem alone came to Rs 54,000,” said Banerjee. 

“The commission asked the hospital to refund Rs 24,000 on other heads and the hospital had deducted another Rs 12,000 because there was some error in their billing system,” he said.