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Drop Hospitals From Insurance List If They Press Patients to Pay in Advance

Published: 08th September 2014 06:00 AM  |   Last Updated: 08th September 2014 02:22 AM   |  A+A-

High-court

CHENNAI: The Madras High Court has indicted the State government for not removing the hospitals, which demanded advance payment for admission of patients and directed the patients to claim the amount from the medical insurance company, from its hospitals network.

A division bench of this court had on an earlier occasion directed the State government to inform every network hospital that if any complaint from claimants regarding demand of money for admission was received, the hospital concerned will be removed from the network. In spite of such a direction, the hospitals were demanding advance payment and the government had not taken any action against them, Justice N Paul Vasanthakumar observed.

The judge was passing orders on two writ petitions praying for a direction to the United India Insurance Company to reimburse the amount spent for treatment. In the first case, a staff of the High Court had admitted his six year old son for treatment. The hospital insisted him to pay the entire amount in advance and he paid `2.98 lakh. However, his son died.

In the second case, Jalaja admitted her husband in a hospital for treatment and she had to part with `2.50 lakh in advance.

When both made the claims, the United Indian Insurance Company refused reimbursement on the ground that the scheme itself was a cashless model, which meant that no reimbursement was permissible and the company would pay the claim to the hospital.

The judge said the petitioners were covered under the TN Medial Health Fund Scheme, which was subsequently modified under NHIS. The modification of the scheme could not be put against the petitioners. They were entitled to claim medical reimbursement, the judge said and told the company to reimburse the amount.

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