From bypass to cancer operations, Maharashtra caps hospital charges for uninsured

TNN | Updated: May 2, 2020, 05:43 IST

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MUMBAI:In a first, the state government has invoked five Acts, including the Epidemic Diseases and Disaster Management Act, to cap treatment rates for the uninsured at private hospitals.
The decision to fix hospital package costs for 173 common procedures has been prompted by numerous profiteering complaints against hospitals from both Covid-19 and non-Covid-19 patients.

The public health department issued a notification on Thursday to regulate rates for angiography, bypass, knee and hip replacement, cataract, hernia, normal and Caesarean deliveries, and even cancer surgeries till the pandemic ends. The order said hospitals cannot charge a mark-up fee of more than 10% on the net procurement cost of consumables such as personal protective equipment or for other items.
City hospitals call reduced treatment rates ‘impractical’
The state notification says items such as implants, lenses, catheter balloons, orthopaedic prosthesis, stents, staplers and pacemakers cannot have a markup of more than 10%.
The rates will be in force till the pandemic ends, the state said.

Following the notification, even the city’s swankiest hospital, for instance, cannot charge an uninsured person more than Rs 12,000 for an angiography, Rs 75,000 for a normal delivery or Rs 86,250 for a C-section. Top city hospitals charge Rs 35,000 to a lakh for an angiography.
Sources said the intention was also to rein in some five star private hospitals (a majority of which are trust-run) and are not under the General Insurance Public Sector Association (GIPSA)—a group made up of four public sector insurance companies—or any of the state insurance schemes, and have a free hand at charging patients.
Public health minister Rajesh Tope said people have paid up to a lakh for a single day’s treatment in a Mumbai private hospital. “While those with an insurance cover are anyway secure and pay set charges, it’s the uninsured who are being charged exorbitantly,” said the minister.
A state source said hospital bills would be monitored and any violation could attract action under the Epidemic Act that has provisions for six-month imprisonment or fine, or both. The notification has reiterated that charitable hospitals should reserve 10% of their beds for the poor and 10% at concessional rates in accordance with the Bombay Public Trusts Act.
The notification has also brought in regulations for hospitals under GIPSA’s Preferred Provider Network (PPN). It said if an uninsured patient were to take treatment there, they cannot be charged more than the rate for the lowest bed category, irrespective of the class the patient is admitted in. This clause will also help an insured person who has exhausted his insurance cover, as once his limit has been exceeded, he has to be extended the lowest bed charges. Over 90% of hospitals in Mumbai Metropolitan Region and Pune are a part of GIPSA’s PPN, the state said.
For hospitals beyond Mumbai and Pune, where most tie up with multiple third party administrators (TPAs) and offer the same treatment at varying rates, the state has said they have to charge the lowest package rates. Dr Sudhakar Shinde, CEO, State Health Assurance Society, said, “We are urging hospitals to follow this rate as people are facing extraordinary hardship due to the outbreak and the economic conditions.”
Reacting to the diktat, private hospitals in the city have called the rates “impractical”. “How can a hospital in the city and the suburbs provide treatment at the same cost?” asked a hospital head.
Dr V Ravishankar, COO of Lilavati Hospital, said they were already treating patients from the poor and weaker category. “In fact, we have a Covid-19 positive patient on ventilator whom we are treating for free right now,” said the head while maintaining the hospital’s rates have not changed post the pandemic.
Dr P M Bhujang of H N Reliance Hospital said they were studying the notification and have sought some clarity. Another hospital said they will be discussing the matter with state authorities.