Misguidance, Mental harassment and unrealistic/wrong billing by Fortis Hiranandani Hospital Vashi, N

Hi,

This is in regard to the issue in billing at Fortis Hiranandani Vashi Hospital and misguidance by hospital TPA department regarding payment of outstanding amount when enquired prior to admission.

Approval letter of Insurance company, Hospital Bill is attached

My father has been gone through laparoscopic surgery for removal of gallbladder on 31st dec at fortis Hiranandani, Vashi Navi Mumbai
Initially when we enquired about the surgery package on 29 December, Mr Ajay Gaikwad from TPA department of Fortis shared the package details of General ward and Twin Sharing room. He instructed that our policy has the limitations for room rent of 3000 and if required can opt for a higher rent room. Then I asked what would be the impact if I go for a higher rent room which the policy doesn't include. He stated that only the difference of both packages and the copay amount of 10% will be the payable amount to the patient (as a proof I have the call recording). So that amount may be around ₹25000.

Post surgery at time of discharge the insurance company only approved ₹57131(45% on prorata basis). The total bill was ₹ 1,11,739.

Insurance company has already given the pre-approval of ₹79,776

When asked for reason of less approval Health India (TPA) stated as room rent is higher considering the entire package is reduced and approved on a prorata basis. Also stated the hospital has misguided. And when asked by the hospital they stated its not our issue, it's the Insurance company issue.

Doctor flagged out for discharge at 1:00PM but the Hospital didn't release the patient till the final approval was not received from the insurance company. The patient has hypertension and sugar, but the Hospital authority didn't release the patient. Indeed it was mental harassment by the Hospital and the hospital also played with the mental health of the patient by not answering on what is happening for delay in discharge. Finally, after a lot of harassment I paid the amount of ₹54,700 to the hospital in dispute. When asked for the letter of payment done in dispute, hospital authority denied. Also in the letter of approval the insurance company stated the investigation charges (₹6237.6 as per hospital bill break up) is included in the package and other procedures charges of ₹2392 charged by the hospital not to be collected by patient. Still the hospital insisted to pay us the complete amount which the insurance company letter stated not to be collected by the patient. Without complete payment, they didn't allow patient to be discharged.


Patient details as per hospital admission
Patient name: Ramesh Sabadra
UHID no. : 1220990
Episode no. : 66923/22/1501
Claim details
Claim no. : HI-OIC-001915391
Policy no. :182300/48/2023/926

This was the sheer harassment and overcharging done by the hospital. Do guide me with the proper channel to file a complaint against hospital authority.


Regards,
Rushabh Sabadra
9028120717