Do the hospitals inflate bills under Medical Insurance?

Answer 1

Yea, there is a tendency among Network hospitals to inflate medical bills be it cashless or under reimbursement procedure. Because under cashless system, the hospitals are to submit their bills at periodic intervals to the Third Party Administrator, who in turn submit their bills to the Insurance company concerned.In this case, the quantum of sum insured coverage of the party gets reduced, whereas the hospitals are benefited from inflated bills, since they have ample scopes for charges not related to the patient or tests not carried, medicines not given. In reimbursement case, the patient party are directly affected since they are to pay first to the hospital authority before discharge of the patient and apply for reimbursement before the T.P.A. which may not be paid in full on one pretext or other.