back arrow Back

Charges denied by Insurance Company

reply Share
12 Dec, 2020 by  Rushabh

Hi,

 

My mother was recently admitted to Kokilaben hospital and we availed the cashless facility available at the hospital. However some of the charges have been deducted by the Insurance company. Some of the charges deducted are as follows:

1) Assistant Doctor

2) PPE Kit - Even though the doctors and staff were not wearing kits how can they charge like this when Covid report came negative

3) Non medical expenses like diaper, underpads, wet wipes

While I understand that non medical items are not covered but why would Assistant Doctor charges get refused? Also is there a way to reverse PPE kit charges or appeal against something that has been charged inspite of the staff not wearing PPE Kits. If I wanted to appeal specifically against this hospital how can I go about doing this?

 

 

 

 

 

like like
0
Claim

2 Answer

Post
20 Dec, 2020
Bwealthy Financials

Dear Rushabh

I am basically a doctor an oncologist from kerala and also run a financial services business- Bwealthy Financial Solutions Private Limited. My reply to you is based on my experience in both medical and insurance field


Insurance companies look at grounds for rejection so that they can save their money. Most policies don't allow for assistant doctor. Hence since you had opted for a cashless policy the hospital should have been aware of this and assisted you by not putting this charge or if this is a charge they cannot avoid due to reasons then insurance companies have policies where thy might not cover.

Again PPE kit has the same issue some insurance policies don't cover. Hospitals usually use PPE kit either when you are in holding area or in your area till the PCR report comes or sometimes routinely for all patients. This is a policy that they adopt to protect their staff and also to comply with the state guidelines. This is often not covered by certain insurance companies, I don't think hospital is at fault because of this. The PPE kit no can go up because each 4 hours they change , there is usually 3 shifts for nurses doctors wear it during rounds, they also come with their assistants hence they also need to wear. If you came via emergency there will PPE used there as well. So basically the number goes up and insurance companies usually don't pay for it unless u go for a covid specific insurance.


Non medical expenses like diaper, other consumables are usually not covered by insurance companies.


Appealing to the hospital may not be of any use as the insurance companies are the ones who usually reject your claims. Usually you have to approach the pro or insurance office with your concerns and ask if there is any possibility to help but I am pretty sure their hands are tied. The only help you can get is from the insurance company as they are the ones sanctioning the claims. I hope you got my point.


Any future assistance you need for any health insurance or any life insurance policies feel free to contact me. Glad to assist you


With regards,


Dr Geomcy George

Director

Bwealthy Financial Solutions Private Limited

like like
0
icon-comment 0 Comments
icon-reply Reply
21 Dec, 2020

Dear Rushabh,


  • As per standard practice, Assistant Doctor (usually a resident doctor) costs are supposed to be included in the Room charges along with patient food charges, nursing charges, etc.
  • PPE Kits: All Insurance companies are now paying for PPE kits within the room charges as a package and not separately. So if they are charged separately there are chances that the insurance company may not pay for it. Here are the agreed charges (that include the cost of per day PPE kit. (Also the fact that you are saying that the doctors were not wearing the kit as per protocol could be the reason why the PPE kit cost would not have been admitted by the insurance company.

  • Non-Medical expenses - are never covered under Health Insurance.


While I understand that non medical items are not covered but why would Assistant Doctor charges get refused? Also is there a way to reverse PPE kit charges or appeal against something that has been charged inspite of the staff not wearing PPE Kits. If I wanted to appeal specifically against this hospital how can I go about doing this?


There is nothing that the insurance company can do here. You will have to take this up in writing with the hospital's public relations desk or administration.


Hope this helps.


like like
0
icon-comment 0 Comments
icon-reply Reply
Discover the best tips for insurance every week!
beshak logo

Beshak is your source for clear, research-backed information & analysis of insurance plans. Our sole focus is to help you make well-informed decisions on insurance. We don't sell or advertise insurance plans or companies.

facebook icontwitter iconlinkedin icon

Beshak is not regulated by the Insurance Regulatory and Development Authority of India (IRDAI) and does not have any alliance or association with any Insurance business. © Copyright 2021 Beshak Solutions Pvt. Ltd. All Rights Reserved.

Disclaimer: The content on the website is purely for information purposes for the public at large, and does not constitute personal financial advice for a specific individual reader.
If you are reading this, it means you love reading the fine print. Why not get paid for what you love doing - Join us by writing to info@beshak.org now 🙂