The private hospitals, which had raised similar concerns over the payment dues during the first wave of Covid-19, said the situation remains nearly the same during the second wave. They said the inordinate delay in reimbursing bills is causing a huge burden on them, as they find it difficult to manage day-to-day expenses.
“The government is yet to reimburse bills worth Rs 70 lakh that we spent on treating the state referred Covid patients. It has been more than six weeks since the second Covid wave began, but we have not received any payment so far. Some amount is also due from the first wave,” said the medical director of a hospital in South Bengaluru, who did not wish to be identified.
The head of another Bengaluru-based hospital alleged that Suvarna Arogya Suraksha Trust (SAST), the government agency tasked with reimbursement of bills, was finding faults in bills that private hospitals share. “Of the Rs 40 lakh worth bills that we submitted during the first wave, SAST cleared bills worth Rs 23 lakh. We had to write off the deficit,” the hospital head said on condition of anonymity.
During the pandemic, the Karnataka government has made it mandatory for all private hospitals to reserve half of their beds to treat Covid-19 patients referred by public health authorities. The state has set an upper limit of treatment cost ranging from Rs 6,200 to Rs 12,500 for general beds, high dependency unit, intensive care unit (ICU) and beds with ventilators.
Private hospitals also pointed out a limitation in the SAST software that allows processing of only up to 2,000 bills a day, covering treatment of both Covid and non-Covid patients. “SAST had an outstanding bill of Rs 170 crore during the beginning of the second wave. The delay is hitting small hospitals hard, especially those outside Bengaluru where around 70 per cent of their bills are pending,” said Private Hospitals and Nursing Homes Association president HM Prasanna.
As a result, Prasanna said, most small and medium hospitals did not admit patients with health insurance this time. Hospitals prefer admitting patients who make cash payments in the remaining 50 per cent of beds, so that they can at least sustain operational expenditure, he said.
Jagadish J Hiremath, managing director at ACE Suhas Hospital in Jigani said the SAST’s criteria to clear bills was opaque. “We have no idea on what basis the team of doctors clear the dues. There is also no functioning appellate authority for hospitals to approach,” he said.
SAST officials refuted these allegations and said they were clearing all the bills that were accurate and were produced within the stipulated time. “Often hospitals do not submit bills at all. This, despite terms and conditions clearly asking them to upload bills within the deadline,” said SAST executive director NT Abroo.
The trust has reimbursed treatment costs of Rs 521 crore (94 per cent) to private hospitals during the first wave and about Rs 130 crore in the second wave, she said.