Why some are out to prove their pneumonia isn’t Covid

AHMEDABAD: In an irony of sorts, while thousands of kin of Covid-19 victims stare at the tough task of proving their kin died of coronavirus to obtain Rs 50,000 ex gratia from the government, there is also a section of people who are forced to take up legal battle to prove their viral pneumonia was not due to Covid and thereby their hospitalization charges should be reimbursed in totality.
Dilip Koradoya, from Dhoraji in Rajkot district, was mandated to approach Rajkot District Consumer Dispute Redressal Commission after the insurance firm deducted half of the bill amount of his son Meet's treatment for viral pneumonia citing government's circular capping hospital charges for Covid-19 hospitalization.
It was only after insurance firm was sued that it settled the dispute and paid amount to Koradiya’s satisfaction.
As per details, Koradiya had bought a Rs 7.25 lakh cover for his family from Star Health & Allied Insurance Co Ltd. His son, Meet, fell sick on September 29, 2020, and he was admitted in a multispeciality hospital in Surat. He was treated for viral pneumonia and discharged on October 5. He footed a medical bill of Rs 2.04 lakh.
In the discharge summary, the hospital stated the patient suffered from viral pneumonia and was not Covid-positive. A day after the discharge, Koradiya asked the insurer for reimbursement.
Insurer okays only Rs 1.01L
The insurer approved Rs 1.01 lakh amount and deducted Rs 1.03 lakh. The insurer cited the Surat Municipal Corporation’s Covid-19 circular regarding hospital charges for Covid-19 to justify chopping reimbursement by half. Dilip Koradoya did not agree with the insurer and claimed that Rs 97,000 amount was wrongly deducted.
The father cited the bill assessment sheet issued by the insurance company in December which mentioned the final diagnosis as viral pneumonia Covid-positive and asserted that this was not true. He claimed that his son was not suffering from Covid-19 and the discharge report clearly said so. He argued that when the patient was diagnosed with viral pneumonia and declared as Covid-negative, the municipal corporation’s Covid19 circular became irrelevant for deducting the amount from Mediclaim.
When the insurer found that the issue had reached the consumer court, it offered to settle the dispute. Koradiya did not have an objection to a minor deduction about cost of certain medicines and hospital discount, and the dispute was settled at additional payment of Rs 83,000. This led him to withdraw his complaint earlier this month.