Private hospitals refund excess bills for COVID care in Maharashtra
Following the COVID surge of 2021 in which India recorded millions of cases and a daily death toll crossing 3500, many people not only lost family members but also faced the burden of heavy hospital bills, far in excess of regulated rates. In Maharashtra, AID partner SATHI worked with grassroots organizations throughout the state to document incidences of overcharging and support people in filing for refunds.
A survey of 2500 respondents in 34 districts found that the average amount of overcharging was Rs. 155,934. To put this into context, minimum wage in Maharasthra is Rs. 12,000 / month. Of the many thousands of patients who reported being overcharged, only a small fraction received at least partial refunds. This points to the importance of preventing overcharging in the first place. Estimates of the total amount overcharged by private hospitals in Maharashtra during COVID comes to 1000 – 9000 crore rupees and may never be fully documented let alone recovered. Had patients never been overcharged, all of this money would be with the people.
The following stories, shared by SATHI give an idea of the arduous process patients and surviving relatives go through in paying medical bills.
Refund Stories of Overcharging by Private Hospitals
Introduction- Hospitals played a very important role during the Covid-19 pandemic. The capacity of the government health system was limited. Hence the support of private hospitals was necessary and received. Despite the adverse conditions, inadequate manpower and lack of resources, the hospitals worked selflessly and to the best of their abilities. During this period lakhs of doctors, medical and non-medical staff were infected with covid and many lost their lives. Whenever the history of the Covid era is written, it will surely include this tireless service of hospitals. But there is a hidden side to this glittering performance, the profiteering of private hospitals. Some hospitals cheated patients by charging exorbitant bills, without which this history would be incomplete.
In fact, it was a rule of the Maharashtra Government that bills exceeding a certain amount should be audited. So, was the system for that properly equipped? And did they enforce the rules? Was the audit done as per the rules or were there any problems?
During the first and especially the second wave of Covid, the number of hospitalizations in Maharashtra was huge. Patients were in lakhs however the number of cases which were audited was only in thousands, the number of those seeking audits remained very small. Why didn’t people make this demand despite having to pay exorbitant bills? Because of lack of knowledge of the rule or lack of belief that this will achieve anything?
Why did hundreds of complainants who paid exorbitant bills want to audit private hospital bills? Did they just expect a refund or more? Did they have to pay the price of this demand? And what exactly did this achieve?
In accordance with these questions, an important development in the Covid period is the audit of medical bills.
Refund stories
1. Anil Chaure
I work as a professor on an hourly basis. Even during the lockdown, we had to go to college. During Covid, I was paid only half of my salary. Even with me, wife and son, it was not possible to run an entire house on half salary. Everything was very expensive. To run the house, both me and my wife were working on crushing tamarinds at a rate of Rs.8/kilo. Our target was to crush 100 kg of tamarind per week. So, no matter how tired we were, we had to reach the target. My close friend died in the second wave of Corona. After which the fear of corona virus became more pronounced. I had to go to college and in that midst, I contracted the covid virus. Initially I was treated by the village doctors. Despite staying in a one room house I stayed apart from my wife and child. But one day the illness became serious. Oxygen beds, ambulances, covid care centers, private-government hospitals, expenses, money, etc. one thing led to another. My father and brother lived next door. He along with my family and friends from the village struggled and finally got me an oxygen bed. It didn’t make a difference so we changed the hospital. The cost kept increasing. Since we had already lost a friend, my friends were determined to save me and they began to raise funds. Villagers, college, students collected Rs. 1,55,000. My family somehow raised some amount. Loans were taken out. All these together came to five lakhs. Due to the treatment and everyone’s hard work, I came out of covid with a mountain of debt. Many complained that the hospitals were billing more. I came to know about this and filed a complaint. The hospital refused to refund the excess bill, instead two doctors called me, saying that we saved your life and now you are taking money out of our pockets. I stuck to my complaint, because I knew the hospital had overcharged. Seeing my resolve to go ahead with the complaint, they got hold of some goons who started harassing me by calling me, coming to my village and threatening me to dissolve the matter. But with the support of the house-village-taluka-district and state-level organization, the truth prevailed. And finally, the hospital had to pay back the excess amount of 79 thousand rupees.
2. Shubhangi Gaikwad
“Expenses of 15 to 20 thousand per day, rush for getting our hands on remdesivir, my husband standing at the door of death in the hospital… in the midst of this stressful situation the hospital was demanding money”. In order to save a life, we went on paying the medical bills. Even after all these efforts, that life could not be saved. Due to the delay in repayment of the medical loan, the lender has put a stay on our land. The lender has named me and my two-and-a-half-year-old baby in this stay order. This incidence is one that that blackens humanity. – Sayings from single women who lost their spouses in Covid-19 pandemic.
3. Megha Tare.
“Tai (sister), did you get the refund check from the hospital? No, madam. Right not my brother doesn’t have the time and I am afraid to go alone, what if they do something to me…” and we both started laughing loudly. I had received a call from her a few days back. “Madam, I have received a letter saying that my case has been settled. After my husband passed away, I handle my own small shop as a way to sustain me and my young baby; my brother helps out with everything. I don’t go out alone. We tried our best to save my husband, after his condition became serious, we shifted him to another hospital…I have a huge debt looming over me and in this condition, I have to take care of my young baby alone”, and she started crying. I somehow consoled her, told her to send me the bill on WhatsApp and hung up the call. My mind would become numb after attending many such calls. After checking the bill, I found out that the hospital had overcharged her by rupees 12,000. I immediately called Tai (sister), and told her to take the bill to the government office. According to the disclosure of the notice issued to the hospital by the government officials, no additional amount has been charged to their bills. Tai used to call me at every stage. I spoke to the authorities myself and presented what the government rules said as evidence of the government decision. Also, there was a discrepancy between the bills with the authorities and Tai’s hospital bills. The bill will only be accepted after the hospital gives it stamp… Tai said “Since my husband passed away, I live in fear. Having lost the courage to travel alone outside, I still came this far. And now it is not possible for me to get a stamp from the hospital…” We as activists try to help out and support wherever we can but in reality, these people/families are the ones who have to fight their own battles. Tai decided to go to the hospital with strength and stamped the bill. The settled case was reopened. The officials issued a notice to the hospital, stating that the patients were given separate bills and the government officials were given separate bills for pre-audit. A notice to refund Rs. 12 thousand was issued and Tai received a check of Rs. 12 thousand from the hospital.
4. Datta Bagal.
Profiteering, experiences of patients’ rights violation. A working-class family, father was a farmer and daily wage worker. They had a total land of 2 acres for agriculture purposes. Crops such as jowar and bajra were primarily grown. The father’s age was 52/53 years, one day while working out on the farm he developed a sudden fever and was rushed to the hospital. He was diagnosed as Covid positive and was admitted for 27 days. A bill of 7 lakh, 14 thousand rupees left the family stumped as to how to repay such a huge amount. The amount of 1 lakh kept aside for agriculture purposes was used up along with selling their gold and farm animals. Despite this, they were falling short. Eventually the family had to take loans from their relatives and 1 lakh 60 thousand was raised. It came to light in the pre-audit that 17,400 rupees were charged as extra by the hospital. The family stuck to their decision of filing a case of overcharging despite slim chances of the money being refunded. The hospital offered them 30,000 rupees and requested the family to withdraw their case. The family refused and went through with the audit. The audit showed that the hospital had included the cost of post-covid treatment in the bill, the first 7 days were covid care and the remaining days were post-covid care. Despite much discussion, the hospital refused to come to an understanding. The hospital didn’t even have the RT-PCR report of the patient. Audit team review was undertaken with the help of the Collector and after a lot of efforts a total amount of 1 lakh 37 thousand was refunded to the family, the highest amount of refund received out of 63 cases. The family received the refund but lost their father.
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September 2022
Note: In 2021-22 AID supported SATHI in providing technical support to patients and relatives filing claims for overcharging. AID continues to with SATHI to strengthen the public health system in Maharashtra, which would help ensure free and high quality health care for all.
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