The Surat Consumer Disputes Redressal Commission (CDRC) has ordered a private hospital and its treating doctor to refund Rs 1.64 lakh to a patient after ruling that he was wrongly billed under a Covid-19 treatment package despite testing negative for the virus. The commission also imposed a penalty of Rs 10,000 as compensation for mental harassment and litigation costs.
Case Background
The case was filed by a 58-year-old Surat resident who had purchased a mediclaim policy of Rs 7 lakh valid from August 24, 2019, to August 23, 2020. During the Covid-19 pandemic, he was admitted to a private hospital in Piplod, Surat, where he underwent treatment between July 22 and July 29, 2020.
Billing Dispute
The hospital raised a bill of Rs 3.71 lakh for the treatment. After discharge, the patient submitted a claim to his insurer. However, the insurance company approved only Rs 1.78 lakh, deducting Rs 1.64 lakh from the claim amount. Aggrieved by the deduction, the patient approached the consumer forum against the insurance company, the third-party administrator (TPA), the hospital, and the treating doctor.
Arguments Presented
During the proceedings, counsel for the insurance company, Amit Sabnani, argued that the patient had been diagnosed with “viral pneumonia, Covid-negative”. Despite this, the hospital had billed him under the Covid-19 treatment package prescribed by the Surat Municipal Corporation (SMC). The hospital bill itself stated that the charges had been levied in accordance with the “Covid-19 package”.
The hospital and doctor, however, contended that they could not be held liable for the deduction since the mediclaim policy had been issued by the insurance company and the reimbursement claim was made to the insurer. They argued that there was no deficiency in service or unfair trade practice on their part.
Commission's Observation
After examining the records and hearing all parties, the commission observed that the patient had been treated for “viral pneumonia, Covid-negative”, yet the hospital had charged him under the SMC’s Covid-19 package rates. It noted that the bill specifically mentioned that the charges were levied as per the “Covid-19 package”. The forum further observed that the hospital and doctor failed to justify why Covid package rates were applied when the patient had not been diagnosed with Covid-19. As a result, it held them responsible for the amount deducted by the insurance company.
Order and Compensation
The commission directed the hospital and doctor to jointly refund Rs 1.64 lakh to the complainant with 8% annual interest from July 31, 2021, the date of filing of the complaint. It also awarded Rs 10,000 towards compensation for mental and physical harassment as well as litigation expenses.
