One of our insured family members was admitted to Dr. D. Y. Patil Hospital and Research Center, Pune, a listed VFM (Value for Money) network hospital under Care Health Insurance.
At the time of admission, the hospital demanded a ₹20,000 deposit, assuring that it would be refunded once the cashless claim was approved.
The hospital sent a pre-authorization request for ₹81,466, and the insurance company approved ₹79,713 via email. Everything seemed fine, and the insured member was discharged without any issues.
However, 10 days later, when the hospital received the actual settlement from the insurance company, they were paid only ₹63,596, instead of the initially approved ₹79,713. The insurance company cited a tariff difference as the reason for this deduction.
Now, instead of absorbing this adjustment (as per their agreement with the insurance company), the hospital unfairly deducted the difference of ₹16,207 from the patient’s deposit, refunding only ₹2,000 instead of ₹20,000!
Why is this a scam?
• The insurance company had approved ₹79,713, but due to tariff differences, they settled only ₹63,596 with the hospital.
The hospital, instead of honoring the agreement with the insurance company, passed the difference onto the patient, despite being a network hospital where cashless treatment should mean minimal out-of-pocket expenses.
• This means patients are being forced to pay hidden charges even after full claim approval!
This kind of malpractice is unethical and unfair. If hospitals can simply charge patients for tariff differences, then what’s the point of network hospitals and cashless insurance?
What can you do?
✅ Always check the final settlement amount paid by your insurance company to the hospital.
✅ Demand a detailed breakup if the hospital refuses to refund your deposit.
✅ Raise a complaint with your insurance provider and IRDAI if you face such deductions.
Hospitals should not be making patients pay for their internal pricing disputes! Stay alert, ask questions, and don’t let hospitals exploit you.
source
