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Rammohan K (CE)     02 June 2014

Sending legal consumer notice to a hospital

My mother recently underwent a surgery (called Deep-brain-stimulation) costing 11 lakhs out of which 8 lakhs can be claimed by group Medical insurance. Since the claim is post-discharge, Insurance firm is asking for detailed breakup bill. Hospital has given me a packaged bill in the begining and after lot of request an approximate break-up bill. The main issue is there is an item "drugs & disposable and devices" in the approximate break-up bill. The device costs Rs. ~6 lakhs (which covers most of the total amount) and the Insurance company is asking for the original Invoice. Hospital is not providing it citing some weird reasons. Hospital is also telling me that the packaged bill is accepted everywhere and it is the problem with the Insurance company.

Finally I'm tired of running between Hospital and Insurance cmpny and planning to send a legal notice to the Hospital. I believe I'm entitled to get the above mentioned Invoice as part of the bill.

Pls suggest me the proper procedure here? If the hospital replies for the legal notice (like a valid legal reply telling to accept the bill already given) then should Insurance cmpny comply with it ? 

 

 

 



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 2 Replies

Kumar Doab (FIN)     02 June 2014

The devices are not manufactured by hospital and are procured……………………………………..at times by obtaining high incentives from manufacturers or their suppliers (Indian/Foreign)…………………………………………………..(Institutional selling) therefore original bill is not supplied. The hospital may claim that it neither manufacturer nor supplier hence it can’t provide original bill. The prices to stockiest, retailer, MRP (margins) are fixed by various laws…………………………… There are tactical ways to circumvent………………………….and you would know that. You may instruct the insurance company (in writing under proper acknowledgment) to depute its official and check whatever record, BILLS it want to and submit his report with a copy to you. You may proceed under expert advise of your lawyer specializing in consumer matters. Your lawyer may opine to pull both hospital, insurance company if the need be to DCDRF.

Dr. MPS RAMANI Ph.D.[Tech.] (Scientist/Engineer)     05 June 2014

You file a case in the Consumer Forum making both the Hospital and Insurance company as opposite parties. In your case each party is turning the other way. When the Consumer Forum asks them they will have to answer to the point.

At the time of taking insurance policy and when you admit a patient to a hospital, they will take your signature on a number of forms containing terms and conditions in fine print. At the time you sign them you will not be in proper frame of mind to read them or even if you read you may not know their import. Some of the terms and conditions will be even unfair or illegal. All these will come to light in the consumer court, which will strike them down.


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