The hospital said it ‘made the correction on its own without anyone having to point it out’
Reji Abraham underwent a hernia surgery at Criticare Hospital, Malad, on Sept 1, with pre-surgery cashless authorisation of Rs 95,500 from his insurance company. The hospital eventually charged him only Rs 75,000. In a letter to Criticare on Sept 3, Abraham’s operating surgeon Dr Ashish Mody had said the case amounted to negligence but reworded it as confusion after TOI sought the hospital’s response.
Calling it “an inadvertent human error” by a non-medical staffer, the hospital said it was a case of miscommunication, not malice. However, during the discharge process the next day, the hospital’s third-party administrator (TPA) staff told his family that an additional surgery “for cancer” had been performed and the total bill was Rs 2.02 lakh. There was no cancer procedure done in the first place,” said Abraham. Abraham told TOI that the billing desk had charged him for a hernioplasty and an omentectomy for cancer. An omentectomy is a standard surgical procedure used in both cancer treatments and complex hernia repairs, but as he told TOI , he had never undergone a cancer consultation or diagnosis. Criticare founder Dr Deepak Namjoshi said the hospital “made the correction on its own without anyone having to point it out”. He said rectification was done “without anyone having to point it out”. In an email response to Abraham’s complaints, the hospital said, “…TPA executive is a non-medical staff member responsible for handling administrative and TPA-related processes. “I wish I had been more circumspect in the wordings of the letter and used the word confusion instead of negligence,” Dr Modi said. He said it was not a scam, but it caused distress to the patient.
Mumbai: A Mumbai-based environmental activist has alleged that a private hospital billed him for a cancer surgery that he did not undergo and rectified it only after he pointed out the discrepancy. “I was asked to pay the rest out of pocket as the claim was rejected. “No advance deposit was collected either. During the billing process, the wrong grade was selected by mistake while entering the procedure details. This was an inadvertent human error.
Pre-approval was done before the patient was admitted.