When a hospital presents an inflated or wrong final bill at discharge, here is the complete guide:
Step 1: Common billing errors. (a) charges for procedures not performed (the bill includes procedures that were not done — e.g., a CT scan that was not performed, a surgery that was not done), (b) duplicate charges (the same item is charged twice — e.g., room rent charged for the same day twice, medicines charged twice), © inflated quantity (the bill shows 10 bottles of IV fluid when only 3 were used — or 20 strips of medicines when only 5 were given), (d) charges for a higher category room (you were in a general ward — but the bill shows a private room), (e) package rate violation (the hospital agreed to a package rate — but the bill includes extra charges that are part of the package), (f) charges after discharge (the bill includes charges for days after the patient was discharged).
Step 2: What to do at discharge. (a) ask for an itemised bill (do not accept a summary bill — demand a line-by-line breakdown with dates, quantities, and rates), (b) compare with the treatment record (ask for the daily treatment summary — compare the medicines and procedures in the treatment record with the bill), © flag the discrepancies (mark each item that is wrong — with the reason: “not done”, “duplicate”, “wrong quantity”, “wrong rate”), (d) refuse to pay the wrong amount (pay only the correct amount — and write “paid under protest” on the bill), (e) demand a corrected bill (the hospital must issue a corrected bill — before you pay).
Step 3: Hospital refuses to correct. (a) the hospital may refuse to correct the bill (citing “the charges are as per our tariff” — but the charges must match the actual services rendered), (b) the hospital may withhold the discharge summary (the hospital withholds the discharge summary until the full bill is paid — this is illegal, the discharge summary is a medical record and must be provided), © the hospital may not release the body (in case of death — the hospital withholds the body until the bill is paid — this is illegal, the body cannot be held hostage for payment), (d) the hospital may not give the original documents (the hospital withholds the original bills and reports — to prevent you from filing a claim or complaint).
Step 4: How to get the discharge summary. (a) under the Clinical Establishments Act and the Consumer Protection Act: the hospital MUST provide the discharge summary (it is a medical record — the patient has a right to it), (b) send a written demand (by email or registered post — requesting the discharge summary within 24 hours), © if the hospital does not provide: file a complaint with the State Medical Council (the Council can order the hospital to provide the discharge summary — and can take action against the doctor/hospital), (d) file a consumer complaint (the withholding of the discharge summary is a deficiency of service — the consumer forum can order the hospital to provide it and pay compensation).
Step 5: File RTI. File RTI with the health department asking for: (a) whether hospital [name] is registered under the Clinical Establishments Act (if yes: provide the registration number and date), (b) the complaint history against hospital [name] (how many complaints have been received — and the action taken on each), © whether hospital [name] has been inspected (if yes: provide the inspection report — including any violations found), (d) the rates approved by the hospital under the package scheme (if the hospital is empanelled under CGHS/PMJAY — provide the approved package rates), (e) the action taken on complaint number [number] filed on [date] (if you have filed a complaint with the health department).
Step 6: Escalation. (a) file a complaint with the State Medical Council (against the hospital and the treating doctor — for unethical billing and withholding records), (b) file a complaint with the health department (the department can take action against the hospital — including cancellation of registration), © file a consumer complaint (the wrong billing is an unfair trade practice — the consumer forum can order refund, compensation, and costs), (d) file a police complaint (if the hospital has committed fraud — e.g., charging for procedures not done is cheating under BNS Section 318), (e) approach the Insurance Ombudsman or the TPA (if the insurance claim is affected — the TPA can re-examine the bill and reduce the wrong charges).
Step 7: Insurance claim. (a) if the insurance claim is rejected or reduced due to the wrong bill: submit the corrected bill to the insurance company (with the supporting documents — treatment record, doctor's note), (b) if the hospital does not correct the bill: file a complaint with the Insurance Ombudsman (the Ombudsman can order the insurance company to process the claim based on the actual treatment — not the inflated bill), © file RTI with the insurance company (if PSU — asking for the basis of claim rejection and the comparison with the hospital's approved rates).