Post-appeal, eye hospital told to pay 100k, insurer 51k
A patient purchased an insurance policy which should have covered the hospital expense but the payout by the insurance company was limited. The insurers informed the client that the policy’s stipulations state that payouts are limited on cashless claims. The patient took the hospital to court and won but an appeal by the hospital proved the insurer was half liable. During Appeal, the courts also forbade hospitals from charging clients outside of the fee structure.
Grewal Eye Hospital in sector 9 Chandigarh admitted a patient named Shabham Khunger who had an insurance policy from the Apollo Munich Health Insurance Company, which was always timely renewed. Her visual deterioration required either of 2 optional surgeries (Phaco or Robolazr), the insurance company was notified and the Grewal Hospital was undeniably covered. :ater the insurance firm stated that cashless requests has been approved for 48k only. Taking the matter to Consumer Forum proved Khunger’s entitlement to full coverage and award of 100k plus 9% interest per annum, 20k as compensation for mental agony plus 15k litigation costs to be paid by the insurance firm. An appeal by the hospital found the district consumer forum to have some fault; the district commission observed that the insurance company only released the payout amount to cover the cheaper surgery, not the more expensive out of the two optional surgeries to try and compel the policy holder to go for a basic surgery. Also, the hospital overcharged the patient due to the acquisition of new machinery. The district commission found both the hospital and insurance firm of unfair trade practice and equally liable to compensate the patient.
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Under section 2 of the Consumer Protection Act 1986, definition of unfair trade practice applied in this case most likely is as follows:
Section 2 (Definitions)
Sub-Section (1), Clause (r) Unfair trade practice;
Sub-Clause (vi): makes a false or misleading representation concerning the need for, or the usefulness of, any goods or services;
Sub-Clause (ix) materially misleads the public concerning the price at which a product or like products or goods or services, have been or are, ordinarily sold or provided, and, for this purpose, a representation as to price shall be deemed to refer to the price at which the product or goods or services has or have been sold by sellers or provided by suppliers generally in the relevant market unless it is clearly specified to be the price at which the product has been sold or services have been provided by the person by whom or on whose behalf the representation is made;
shall be deemed to be a statement made to the public by, and only by, the person who had caused the statement to be so expressed, made or contained.
The involvement of the insurance company most likely inflated the greed of the hospitals; prices are hiked to maximize profits. Some insurance companies will investigate the market to prevent such fraud and some will not inquire about the price hike and over charge their customers on the premiums. Many people will not question the insurance companies of the expensive premiums since insurance is beneficial in nature and since every country’s GDP inflates inevitably; rising costs don’t look suspicious. Since fraud is rampant all over the world, every person should take the time out of his/her day to make sure he/she does not become a victim to such fraud but if they do; the police and courts will protect them.
The exact proceedings that caused this unfair trade practice to come to light only after reviewing the judgment passed by the State Commission, but the news article stated unfair trade practice about the hospital’s pricing and machinery costs applied to their insured patient. Their operating costs are supposed to be divided amongst their fee structures that are applied to all their patients without bias. Every business has the right to turn a profit but highway robbery is never the answer; there are no short cuts to become wealthy. The courts found a patient was mishandled by the hospital and the insuring company.
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