Hospital indicted for levying surcharge

Usha Kedia, who was suffering from orthopaedic problems, was admitted to Bombay Hospital on September 24, 2014. She was operated upon the following day and discharged on September 27. The treatment cost came to Rs 2,10,627. She was covered under a Mediclaim Policy from National Insurance, which reimbursed Rs 1,66,000. So, she was required to pay the remaining amount of Rs 44,627 in cash to the hospital. Similarly, there was a shortfall in payment of the claims for pre- and post-hospitalisation treatment. Out of the total demand of Rs 2,50,281, she received Rs 1,98,584, and the remaining amount of Rs 51,697 remained unpaid.

Kedia complained to the Insurance Ombudsman who failed to redress her grievance. She then filed a complaint before the consumer forum for South Mumbai District. She pointed out that the hospital had collected Rs 32,470 by imposing 20 per cent surcharge on its bill. This included material and medicines supplied in the operation theatre. Kedia contended that the hospital should be directed to abolish the surcharge, or alternatively, the insurance company should be directed to reimburse this amount.

The hospital contested the case contending that there was no deficiency in service and that a dispute regarding the charges or pricing policy would not be maintainable before the consumer fora. It defended the levy of surcharge on the ground that special effort is required to maintain adequate stock of drugs, disposables and other items in the operation theatre, and the cost for this was borne through the imposition of the surcharge. The insurer argued that the full claim was not payable as the deductions were made in accordance with the terms of the policy.

The forum held the complaint to be maintainable as the allegations were in respect of charges levied for services rendered. The forum noted that the hospital had claimed that surcharge was not being levied on pharmacy bill but had still imposed a surcharge on pharmacy items supplied in the operation theatre. Since there was no legal provision which permitted the imposition of a surcharge, the forum held that its imposition would constitute an unfair trade practice. Accordingly, by its order of May 22, 2019, delivered by M P Kasar for the Bench headed by Sneha Mhatra and D S Paradkar, the forum ordered Bombay Hospital to refund the surcharge along with 9 per cent interest from the date of complaint.

Regarding other deductions by the insurance company, the forum held that the disallowance of the expenses towards doctors’ fees and other medical items was unwarranted under the terms of the policy. It ordered the insurer to reimburse the expenses along with 9 per cent interest from the date of complaint. 

In addition, the forum ordered the hospital as well as the insurer to separately pay Rs 7,500 towards compensation and Rs 5,000 as litigation costs.
 

The writer is a consumer activist