Hospital bills on the rise.[Photo/http://cdn.kdrtv.com]
Private health care insurers are bearing the burden and pain of skyrocketing medical bills, which they attribute to fraud being perpetrated by hospitals. The inflated charges do not only erode insurance companies’ profitability but also their ability to keep premiums low and expose policyholders to the risk of overshooting their cover limits leaving them with no option but to foot their own bills.
According to policyholders, Wikendi spoke to, private healthcare institutions ‘drain’ medical covers by inflating charges. “The healthcare service charges for insured persons seem to be high but not in tandem to rendered services,” said Joseph Lore as he discharged his wife from a city hospital after a two-week stay. Lore disputed the bill saying the cost of drugs and procedures were inflated or not provided.
For Alice Akinyi, whose son was admitted to the same facility, it was a shocker after the hospital asked her to pay for out-patient charges despite her son being an in-patient. “Some private hospitals appear to be fleecing patients through over-pricing drugs and charging for services not rendered,” she said. A pharmacist, who examined the drugs on the request of the parents, said the hospital had over-prescribed drugs.
A close examination of the drugs administered to the patients while in admission were generic versions but upon discharge, they were given original drugs – which are more costly. Association of Kenya Insurers (AKI) Executive Director Tom Gichuhi said hospitals should introduce cost ceiling for procedures to make it difficult to inflate bills. “Hospitals and doctors should cap costs of procedures,” he said.
He said AKI and other stakeholders are pushing for an audit of medical bills by a regulatory body. “We are waiting for government’s reaction on over-billing which is depleting profitability of the insurance sector. The proposed audit should help clear the air and remove the perception all hospitals cheats,” Gichuhi said. Insurance Regulatory Authority also welcomes an independent vetting of bills before they are paid by insurers.
The regulator is rooting for a medical board that will oversee critical cases to avoid lapses in treatment. “The board will not only ensure better treatment, but the patient will access multiple doctors to review their cases,” Caleb Mugendi, an analyst with Cytonn Investment said.
Indeed, a section of private hospital doctors says the issues affecting billing of insured patients need to be streamlined. “It will need a really Herculean effort to ensure every bill is scrutinized and the charges are fair.
Such consistent screening seems logistically difficult and hospitals know that. Eventually, many will manage to get around the screening and have their way, but screening will help curb over-billing,” said a senior medical doctor, who do not wish quoted said. He wants a ‘third umpire’ set up to settle issues of overbilling.