No bedside bargain on doctor’s visiting fees for insurers

Vadodara: In a ruling with wider implications for holders of health insurance in Gujarat, a Vadodara consumer forum ruled held that a doctor’s bedside visits during hospitalization form an essential part of medical treatment and their fees must be reimbursed under an insurance claim, rejecting an insurer’s deduction terming visit fees ‘extras’.The Vadodara district consumer disputes redressal commission (additional) passed the order after a complaint was filed by Jatinkumar Rana, whose son was diagnosed with viral hepatitis and admitted to hospital in April 2023.Rana incurred medical expenses of Rs 25,676 and submitted a claim to Aditya Birla Health Insurance Company Ltd, with which he held a health policy. The insurer reimbursed Rs 16,576, deducting the balance under various heads.Objecting to the deductions, Rana approached the consumer forum in Aug 2023, seeking payment of Rs 9,100 with 12% interest and Rs 5,000 each towards legal costs and mental agony. The insurance company did not file a reply before the commission.The forum examined the medical bills and arguments placed on record. “Our argument was that a doctor’s visit is necessary to check the patient’s health and it is a part of the treatment in the hospital,” said Dinesh Lalwani of Grahak Suraksha Jagruti Manch, which represented Rana.While the commission said certain deductions, such as miscellaneous and registration charges, were reasonable, it faulted the insurer for excluding the doctor’s visiting fees. “The opponent deducted Rs 2,000 towards visit charges for two days. When a patient is in hospital, it is necessary to check if the patient’s health is improving. The complainant is entitled to get visit charges of Rs 2,000,” the forum observed.The commission directed the insurer to pay the Rs 2,000 for visit charges and Rs 6,000 deducted for room and nursing charges. It also ordered payment of Rs 1,000 as compensation for mental agony and Rs 2,000 towards legal costs.