Simplify medical insurance claims process: Delhi HC to govt

The court also raised concerns over the rising instances of harassment faced by patients and their families during the bill-settlement process

The Delhi high court has asked the Centre and Delhi government to develop a mechanism to streamline the settlement of medical bills by insurance companies, so that patients are not harassed or denied timely discharge by hospitals.

(HT Archive)

A bench of justice Neena Bansal Krishna said that both the Union and Delhi governments must work in coordination with the Insurance Regulatory and Development Authority (IRDA) and the medical councils of Delhi and India to formulate the system.

The court also raised concerns over the rising instances of harassment faced by patients and their families during the bill-settlement process, blaming both hospitals and insurance firms for delays and prolonged procedures that add to patients’ mental trauma.

“Though several courts have recommended a regulatory policy and even a Charter of Patients’ Rights has been proposed by NHRC [the National Human Rights Commission], no final redressal has yet been worked out,” the court said. “This issue must be taken up at the level of the state and central governments, in consultation with IRDA and the medical councils, to streamline the discharge process and settlement of medical bills.”

The observations were made in an April 17 order in response to a plea 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.

In his plea, Garg said that after undergoing surgery at the hospital in 2013, he was charged a total of ₹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 ₹53,000 shortfall from Garg’s deposit.

Garg alleged this was part of a larger conspiracy by the hospital to defraud patients and sought criminal proceedings against the hospital authority.

While the high court dismissed the plea, ruling that Garg had failed to prove any fraudulent intent, it took note of the broader issue of patient harassment during billing and discharge.

“Before parting, it would be pertinent to record that such incidents of alleged harassment felt by the patients in settling their final bills is not an untold story, but is frequently suffered,” the court said. “Their harassment is compounded by the fact that they are just emerging from the trauma of illness, only to face more stress during discharge due to long procedures and delays by insurance companies.”

The court acknowledged the mental toll on patients and their families, who are “pushed to follow up with the insurance companies to obtain necessary approvals,” often caught in a system riddled with inefficiencies.

It reiterated the need for a regulatory framework that ensures swift and transparent communication between hospitals, insurance companies, and patients to avoid such distressing situations in the future.