A consumer commission in Gujarat has directed a private hospital and a doctor to refund Rs 1.64 lakh to a patient after finding that he was billed under a Covid-19 treatment package despite testing negative for the virus.
The Surat Consumer Disputes Redressal Commission (CDRC) also awarded Rs 10,000 as compensation for mental harassment and litigation expenses, holding the hospital and treating doctor responsible for the disputed charges.
How The Dispute Began
The case was filed by a 58-year-old Surat resident who had purchased a mediclaim policy worth Rs 7 lakh. The policy was valid from August 2019 to August 2020.
During the Covid-19 pandemic, the man was admitted to a private hospital in Surat's Piplod area between July 22 and July 29, 2020, for medical treatment.
Following his discharge, the hospital issued a bill of Rs 3.71 lakh. The patient later submitted the bill to his insurance company for reimbursement under his mediclaim policy.
Why The Insurance Company Deducted Rs 1.64 Lakh
While processing the claim, the insurance company approved only Rs 1.78 lakh and rejected reimbursement of Rs 1.64 lakh.
The patient subsequently approached the consumer forum, naming the insurance company, the third-party administrator (TPA), the hospital and the treating doctor as parties in the complaint.
During the proceedings, counsel representing the insurer argued that the patient had been diagnosed with "viral pneumonia, Covid-negative".
Despite this diagnosis, the hospital allegedly billed him under the Covid-19 treatment package prescribed by the Surat Municipal Corporation (SMC).
Consumer Commission Finds Fault With Hospital Billing
After reviewing the documents and hearing all parties, the commission noted that the patient had not been diagnosed with Covid-19.
The forum observed that the hospital bill specifically mentioned that the charges were levied according to the SMC's Covid-19 package rates.
The commission further stated that neither the hospital nor the doctor was able to satisfactorily explain why Covid treatment package rates had been applied to a patient who had tested negative for the virus.
As a result, the forum concluded that the hospital and doctor were responsible for the amount that was ultimately deducted from the insurance claim.
Hospital And Doctor Ordered To Pay Refund With Interest
The commission directed the hospital and doctor to jointly refund Rs 1.64 lakh to the complainant.
In addition, the amount will carry annual interest at the rate of 8 per cent from July 31, 2021, which was the date on which the complaint was filed.
The forum also awarded Rs 10,000 towards compensation for mental and physical harassment, along with litigation costs.
Significant Consumer Rights Ruling
The decision highlights the importance of accurate medical billing and accountability in healthcare services.
The commission's ruling makes it clear that hospitals must justify the treatment packages and charges applied to patients, particularly when such charges directly affect insurance reimbursements.
The case also serves as a reminder that patients have the right to challenge disputed medical bills and seek redress through consumer forums when they believe they have been unfairly charged.
Inputs from TOI
