Retired IIM-Ahmedabad professor teaches hospital and insurer a lesson for Rs 9,603 deduction

AHMEDABAD: When a hospital fails to disclose all pertinent information regarding treatment and the insurance firm refuses to pay the medical bill in full, most of us would think that is the norm. Faced with a similar situation, a retired faculty member of the Indian Institute of Management Ahmedabad, however, dragged the hospital and the insurance company to consumer court and got them to pay up for their deficient service after the insurer deducted Rs 9,603 from a bill of Rs 35,388.
The hospital has been asked to pay Rs 25,000 as compensation and another Rs 5,000 towards legal expenses incurred by K V Ramani, who served as a professor with IIM-A for decades. An expert in hospital management, he had founded the Centre for Management of Health Services at the institute in 2003.
In March 2012, Ramani’s son Akshay suffered from breathlessness and was rushed to Sterling Hospital. After a couple of hours in the emergency unit, Akshay’s condition stabilized and he was discharged the next day. The hospital charged Rs 35,388 for the treatment and the insurer, Oriental Insurance, cleared the bill after deducting Rs 9,603. This did not go down well with the professor.
Ramani filed a complaint with the Consumer Dispute Redressal Commission, Ahmedabad (Rural) for deficiency in service on part of the insurer and the hospital. While the forum ordered the insurance firm to make full payment, there was no order against the hospital.
In 2014, Ramani filed an appeal in the Gujarat State Consumer Dispute Redressal Commission, questioning the charges levied for treatment. He claimed that the patient had become normal after 2-3 hours in the emergency room without any serious intervention, and was then admitted as a normal patient. “To claim higher bills from insurance company, the hospital management found a method as per their arrangement inter se to which the patient or consumer is not a party,” he claimed.
Besides, Ramani also claimed that the hospital did not disclose what treatment was given to his son. The discharge summary also revealed only the follow-up plan. He cited the norms prescribed by the Medical Council of India making it mandatory for hospitals to supply treatment papers and discharge summary within 72 hours. Similar guidelines have been issued by the National Accreditation Board for Hospital and Health Care, and the Charter of Patient’s Rights by the National Human Rights Commission.
Ramani complained that the hospital did not provide case papers and the discharge summary did not reveal information about the procedure performed, medication administered and treatment provided.
The state commission accepted Ramani’s arguments and concluded that there was deficiency in service on part of the hospital management and awarded Rs 25,000 compensation. The hospital has also been asked to pay Rs 5,000 extra to Ramani towards legal expenditure.
Ends...