Hospital — Surgical & Medical Bill Mysteries

State of the art Super Speciality Hospital / world-class / Super-specialty tertiary care hospital / Separate Intensive Care Units (ICU) for each speciality (MICU, CCU, SICU, NICU, PICU) / State-of-the-art modular operation theatres/Patient care areas to suit all economics / Radiology-MRI,CT, X-Ray, Ultrasound / Endoscopy, Ultrasonography, Bronchoscopy / NIC-ECG, 2D Echo, TMT, Holter, PFT / Cathlab with imaging equipment / Birthing suites with complete infant care.

At least once in our lifetime — We all visit the so called Private Hospitals with the above tag lines … either for our self or for our loved ones and sometimes we also face the responsibility of clearing the Hospital bill payments when called from IP (Inpatient Billing Dept) to clear our dues before getting discharged

If your answers are YES to all the questions — Don’t read this !

But

If your answers are NO for at least any one of the below questions — then this article is for you. You should read it.

Question 1 :

I am consistently not surprised at the total bill whenever I received the bill from the IP billing counter and always find the bill to be the amount what I estimated earlier before admission? Yes / No

Question 2 :

I always have a habit of double checking all the line items in the bill and ensure I am clarified of everything before paying the bill ? Yes / No

Question 3 :

When the discharge is informed to me , I don’t feel restless and anxious to reach home as soon as possible from the hospital & to finish the billing formalities at the earliest — Instead I feel calm and composed and ready to wait ? Yes / No

Question 4 :

Before admission , I am always clear & clarify about the estimate of the surgery/ hospitalization & recurring daily charges like room rent / Nursing charges/ Duty Medical Officer charges / Patient Utility Charges & one time charges Reg charges / Medical Record charges / Diet charges / Nutritional Assessment charges etc … Yes / No

Question 5 :

I always meet my treating doctor/ Operated Surgeon and show the bill and get his confirmation before paying. I always wait even if he is in procedure or busy in OP consultation before clearing my bill. Yes / No

With my experience in Health Care for the last 2 decades, felt this article as my moral responsibility to clarify the general public !

Before Admission :

Once you are advised to get admitted by your Doctor — You must clarify the below things before getting admitted

a. Clarify with the doctor — whether this hospitalization will be covered under insurance. ( Proper admission /Observation)

b. If you are kept for 1–2 days observation you may not get your insurance approval, the guidelines for approval from insurance are vague yet complex and not clear, so your insurance submission can be denied stating the reason as “ You are not sick enough to need hospital Admission ! “ and Hospital will request to clear the payment by cash.

c. If that is the case, its better to get treated as outpatient rather than inpatient. (You should be aware the charges of SAME X RAY is different for Outpatient & Inpatients that too there is staggered price depending on your room category )

To be more clear — A X ray which is charged Rs.400 for OUTPATIENT is charged as below

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Can be verified in any multispeciality Hospitals !

d. So it’s better to get treated as an Outpatient in all means for not so severe complaints .

e. Get the tentative written quote for the surgery / hospitalization with the no of days stay / consumable charges ( Implants/ Angioplasty) — However you should also understand that this is approximate and it can bound to increase 10–20% more or less (Always more ) so that you are mentally prepared with the expenses.

f. Also understand & get clarified regarding the ONE TIME CHARGES & RECURRING CHARGES ( It differs from each and every hospital )

One time Charges :

· Registration charges : One time Inpatient charges are charged by all the hospital for every inpatient admission (Anywhere between Rs.200 to Rs.1000)

· MRD charges — Medical Record Charges: to store your physical medical records — Charged between Rs.500 to Rs.1000

· Insurance Processing Fees — Only for insurance patients between Rs.500 to Rs.1000

· Diet Planning charges/ Nutritional Assessment charges : Charged between Rs.500 to Rs.1000

· Patient Utility Charges/ Management charges — Charged 4% to 5% of your total bill .

Recurring Charges :

· Room rent Charges — Generally the room rent differs based on your selection from General ward ( Starting from 2000 ) to 12,000 to Suite room. ( Separate charges for ICU equal to Suite room)

Most of the Hospital will reveal only this when you ask for the recurring charges

· But the fact is , there are more

o Nursing Charges

§ Recurring daily like room rent ( Charges depends on the room selection varies from Rs.1000 to Rs.4000)

§ DMO charges ( Duty Medical Officer Charges ) — depends on the room selection varies from Rs.2000 to Rs.4000) — You are asked to pay this even though the medical officer has never visited your room once.

§ Doctor Visit Charges — Charged on daily basis based on the visits made by your doctor (Ranging from Rs.1000 per visits* no of visits per day) — Keep a close eye & note on the Doctor visits as the no of visits are usually marked by the nurse and there are high chances the number of visits are duplicated by mistake and you end up paying more. Also check with the doctor if you feel that there are frequent visits by your Doctor or other Specialist doctors.

§ ICU consultant Charges — If admitted in ICU — there will be daily charges of Rs.4000 to Rs. 6000 other than the ICU charges.

So, you will be paying a total of Rs.12500- Rs.13000 and not Rs.4000 for a private room as you think as recurring Charges in any multi-speciality Hospitals

( Rs.4000 Room rent + Rs. 1500 Nursing Charges + Rs.2000 DMO charges + Rs. 2000 — Minimum 2 Doctor Visits per day + one time charges of Rs.200 — Registration Charges + Rs.500 MRD charges + Rs.1500 Insurance Processing Charges + Rs.1000 Diet Planning Charges )

During Admission

· Create a habit of visiting the Inpatient billing Department at least once a day during your visits to the hospital & keep in touch with anyone of the billing executive.

· Know them by name and get the extension number to reach the IP department in case if you cannot visit- you can keep in touch through phone.

· Ask them to send the approx. bill everyday so that you are keeping a track and you are not taken into surprise after 10 days of Hospitalization.

· If the patient is on long stay, tell the billing exceutive to alert you if the daily expenses exceeds the average of the first few days.

· This will keep the billing person to be more careful, accountable & bit serious compared to the other bills they are handling. Also he will inform the department members to be very careful with your bills. With 20–30 discharges they are really busy and more mistakes are bound to happen . This act of yours will minimise that.

· This will keep you in track with the expenses and also if you feel the bill is going beyond your expected value — you can discuss shifting the patient to smaller facility / discharge.

· Also keep a track of the bills paid and have the hard copies of all the bills together which can be verified during the discharge .

· Also you will be dispensed medicines in your room with a bill — get all the medicine bills together and file it date wise as those will be added to your final bill.

After Admission :

· Once you get the discharge intimation — Decide among your family members and nominate only one person to deal with the billing.

· Ideally the person who is in touch with the billing executive will be right person to understand the bill better.

· Don’t be anxious & restless to get home once you get the discharge intimation.

· You will be issued a consolidated bill — from which you will not understand anything.

· ASK FOR THE DETAILED BILL DATE WISE- They may tell that it will take some time — relax and wait for the detailed bill which will run to pages.

Things to check in the detailed bill:

· Date of Admission & Date of Discharge ( No of days ) — Time of admission — Suppose if you are admitted by 10 am — one day hospitalization is completed by next day 10 am . Calculate the no of days accordingly. Most of the times by mistake the billing person would have calculated one day more or less, Inform them whatever may be the case.

· ICU Stay ( If any ) — Like above.

· No of Doctor Visits — As informed above

· Pharmacy bills — To be verified with your bills — if you feel that there is an addition other than your bills. Ask for a clarification and get the hard copy of the missed bill — Check the date & time . Also check whether there is any duplication of the same bills.

· Pharmacy Returns: Some medicines are taken back from your room during discharge — Check whether the same as been deducted from the final pharmacy bill.

· Also feel free to ask the consultant if you find any high value medicines.

· Ventilator Charges / O2 charges — calculated on the no of days used inside the ICU ( whenever you visit the ICU — keep a track of dates when the support equipment are given and withdrawn)

· OT Charges -It depends on the no of hours — Also check with the surgeon once whether it is correct ( There are instances where the OT technician has added 0 next to 1 mentioning as 10 hours instead of 1 hour and you will paying 10 times more than the actual.

· Also check the high value consumable cost & feel free to discuss with the consultant and he will be happy to clarify.

· Blood Products used if any to be checked without fail. You need to understand sometimes blood is reserved as a precaution and will not be used. So only reservation charges are to be added if not used, there are chances by oversight entire blood charges may be charged.

· Investigations — with date to be verified. ( Highest chances of wrong entries possible due to high load in radiation & lab )

· Also feel free to ask the billing department if you feel anything which you cannot understand and they will usually ask us to check with the consultant — feel free to do that .

· Make a complete list of things to be clarified before meeting the consultant for a final time as their time is very precious and they will also feel irritated if your are coming up with new questions in a short time.

· Most of the consultants will be very happy to clarify and also waive off things which are wrongly charged and will inform the billing department to do the needful which can save you many thousands .

Also if there is a delay in discharge due to lack of coordination inside the hospital like to follow-up care arrangements; check documentation completion; issue discharge letter from general practitioner (GP); reinforce patient behaviour recommendations and rehabilitation; confirm and finalise transport, bill not ready etc — the hospitals are not supposed to charge extra day rent which will also add other charges like DMO, Nursing charges etc. Be aware .

Please understand , Hospital Discharge is not the end point, but rather one of the multiple transitions in the patient care journey and there is a huge expenses round the corner . You will still receive care after leaving the hospital. After discharge, you’ll go through a transition of care. That means you will now have a different level of medical care outside of the hospital. For example, you may go to a skilled nursing facility if you need some level of further care and are not yet ready to go home. If you need physical rehabilitation, you will go to a rehab facility.

Happy Discharge

Dr.Senthil Kumar