The Delhi High Court has directed both the Union of India and the Government of National Capital Territory of Delhi (GNCTD) to streamline the settlement of medical bills by insurance companies, so that patients were not harassed or denied timely discharge by hospitals.
The single-judge Bench of Justice Neena Bansal Krishna ordered both the Centre and the Delhi government to work in coordination with the Insurance Regulatory and Development Authority (IRDA), along with the medical councils of Delhi and India, to formulate the system.
Noting the rising instances of harassment faced by patients and their families during the bill-settlement process, the single-judge Bench pulled up the hospitals and insurance firms for delays and prolonged procedures adding to patients’ mental trauma.
The High Court said that although several courts have recommended a regulatory policy and even a Charter of Patients’ Rights was proposed by the National Human Rights Commission (NHRC), no final redressal has yet been worked out.
The High Court made these observations on April 17 on a petition filed by Shashank Garg, challenging a May 2018 decision by a city court to discharge three employees of Max Super Specialty Hospital in Saket in a cheating case.
Garg said in his petition that after undergoing surgery at the hospital in 2013, he was charged a total of Rs 1.73 lakh. Though he was covered under a cashless insurance scheme, the hospital made him deposit the full amount as a security, promising a refund once the insurer paid its share.
However, despite the insurance company’s claim that the bill had been paid in full, the hospital maintained that it had received a lower amount and adjusted a shortfall of Rs 53,000 from Garg’s deposit.
The petitioner alleged this was part of a larger conspiracy by the hospital to defraud patients and sought criminal proceedings against the hospital authority.
While dismissing the plea on the grounds that Garg had failed to prove any fraudulent intent, the single-judge Bench took note of the broader issue of patient harassment during billing and discharge.
It said such incidents of alleged harassment felt by the patients in settling their final bills was not an untold story, but frequently suffered. Their harassment was compounded by the fact that they were just emerging from the trauma of illness, only to face more stress during discharge due to long procedures and delays by insurance companies.
It further highlighted the mental toll caused to patients and their families, who were pushed to follow up with the insurance companies to obtain necessary approvals, often caught in a system riddled with inefficiencies.
The High Court reiterated the need for a regulatory framework to ensure swift and transparent communication between hospitals, insurance companies and patients to avoid such distressing situations in the future.
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