As many as 2,606 complaints have been lodged with the state government in the last six months by patients across Maharashtra, who were asked to make out-of-pocket expenditure amounting to Rs 2.80 crore by hospitals despite being eligible for the cashless health insurance scheme.
Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) officials initiated an inquiry and got at least Rs 1.35 crore refunded to patients by these hospitals.
Data from July 2018 till now shows patients were duped the most for cardiology procedures, indicating how doctors take advantage of patients when it comes to stents, angiography and other heart-related surgeries. In 918 cases (44 per cent), cardiology patients were asked to make payments for surgery over and above the fixed cost that the government pays a hospital.
The MJPJAY is a state-run insurance scheme that covers 2.25 crore families and provides a maximum cover of Rs 1.5 lakh annually for 971 listed procedures. The scheme has 492 empanelled hospitals across Maharashtra that provide free treatment to patients and are paid by the insurance company. The scheme runs parallel to the national scheme, Pradhan Mantri Jan Arogya Yojana.
According to Dr Sudhakar Shinde, a 24-hour dedicated call centre takes complaints from patients for both the schemes. “Calls either come for inquiry or for complaints against hospitals,” he said.
The maximum complaints (1,138) came against hospitals in Pune, followed by Mumbai (725).
Meanwhile, the state government has renewed its tender for one more year with the National Insurance Company (NIC), bringing down the rate of insurance premium per family from Rs 690 to Rs 640. Officials have been rigorously negotiating with the insurance company over the premium cost. The decrease in premium cost is expected to save the state government Rs 111 crore annually.
The scheme began in 2012 at a premium of Rs 333 per family. Till now, over 21 lakh patients have been treated under
the scheme.
