Allegations of Health Insurance Misuse by Hospitals

KOCHI: Complaints alleging the misuse of health insurance facilities by private hospitals in the city, particularly in paediatric departments, have surfaced on social media.

Some parents have alleged that children are unnecessarily admitted to intensive care units (ICUs) or kept in hospitals for extended periods for relatively minor illnesses, resulting in higher medical expenses and insurance claims. There have also been allegations of unnecessary medical tests and delays in providing test reports.

Namsheed Valiyakath, the father of an eight-year-old boy, alleged in an Instagram post https://www.instagram.com/p/DbOPg-Skr_C/?img_index=7&igsh=MTN6M3c5ZWQ4Mmg2dg== that he took his son to Ernakulam Medical Centre (EMC) after the child developed a fever. The child was taken to the casualty in a wheelchair. However, Namsheed alleged that before treatment was initiated, hospital staff asked him to complete the registration process and pay for the consultation and blood tests.

According to him, the child was not immediately treated at the casualty and the family was instead directed to consult a paediatrician on the third floor. The child was taken there in a crowded elevator, but the doctor at EMC was not available when they arrived.

Namsheed said the doctor arrived after about 10 to 15 minutes and, following an examination, informed them that the child was dehydrated and required intravenous fluids.

“We informed the doctor that the blood test could be conducted while the drip was being administered and that, if the tests indicated any serious condition, we were willing to admit the child,” he alleged.

However, Namsheed alleged that the EMC hospital staff insisted that the child be admitted for 24 hours. When the family informed the staff that they had health insurance coverage, they were allegedly told that the child would have to remain in the hospital for two days because the insurance department would not be functioning on Sunday.

Namsheed alleged that the hospital was attempting to keep the child admitted for three days in order to increase the amount claimed through insurance. The family subsequently signed a Leaving Against Medical Advice (LAMA) form and proceeded with the discharge. He also alleged that they were asked to pay Rs 20 at the pharmacy before leaving and had to spend another 15 minutes waiting in a queue.

The family then took the child to B&B Memorial Hospital in Thrikkakara. According to Namsheed, the child was given intravenous fluids at the casualty immediately, before being examined by a paediatrician. After the treatment, the child reportedly felt more comfortable. The doctor prescribed medication and discharged the child.

In another complaint, the family of a two-month-old baby, represented by the child’s mother, Mini P.D., alleged that they were dissatisfied with the care and treatment provided to their child.

According to the family, the baby was taken to the hospital after developing an illness and, following the doctor’s instructions, several tests, including a blood test, were prescribed. The blood sample was collected from the paediatric section at around 4 p.m. During the procedure, the parents noticed a scratch on the baby’s nose, accompanied by some bleeding.

The parents alleged that the nursing staff failed to handle the infant with the necessary care and attention.

Later that evening, at around 9 p.m., the baby was admitted to the paediatric NICU. According to the parents, a staff member attached a urine collection bag to the baby for a routine urine examination.

The parents alleged that five urine collection bags were used over two days, but the required urine sample could not be collected. They said the baby instead passed urine into the diaper, after which a tube was also used in an attempt to collect the sample.

The parents said they were extremely distressed that their two-month-old baby had to undergo repeated and uncomfortable procedures, which they attributed to what they perceived as a lack of experience and care.

They claimed that a similar test had been conducted successfully at another hospital earlier the same morning, where a urine sample was collected using a urine collection bag without difficulty.

The parents said they expected nursing staff handling infants to have a high level of experience, skill, patience and compassion. They urged the hospital management to investigate the incident and take appropriate measures to prevent similar experiences for other children and their parents.

There are also reports that dehydration among children are increasing in the State. It is pointed out that the reason for dehydration is allegedly due to the negligence of the neonatology department.

However, some comments responding to Namsheed’s Instagram post questioned whether the child should have been taken to hospital earlier after developing a fever. One commenter suggested that the child’s condition may have worsened because medical attention was sought only the following day.

Another commenter said decisions regarding treatment should be made by doctors based on their medical assessment rather than by parents.

Some parents, however, said they had not experienced similar problems at the hospital. One parent said she had delivered her child there and had taken her child to the hospital several times over the past seven years, including late-night visits to the casualty when the child was unwell, without encountering such an experience.

Other commenters supported Namsheed’s complaint, saying they too had faced similar experiences at private hospitals. One commenter alleged that many private hospitals were primarily focused on increasing revenue from patients.