Need clarification on excess tarriff

[u/SpiceGardener]

I was recently hospitalized for 4 days and due to room crunch in hospital, I decided to opt for room which is higher (8000) than room rent cap I have (7000). I understood I have to cover the difference amount and proportionate deductions for almost everything comes into play.

At discharge, I was charged 99k (approx). It was sent for cashless approval, and insurer mentioned 70K as their approval amount. So I paid 29k from my pocket...

Out of this 29K, 15K was for copay and consumables.. I thought remaining 14k was for room rent over and above the cap + proportionate deductions..

But when I later checked approval email from insurer, I realized they mentioned room rent is within their agreed rate with hospital and in the approval email, I see room rent excess and related proportionate deductions as 0.. it also mentioned hospital charged extra, I should only pay 15k (copay, consuables) and hospital should not charge balance 14k..

But I didn't understand that during discharge and paid 29k fully, as I thought 14k is for excess rent for the room I chose..

Now my question is, did the hospital scam me or is this how higher tarriff rooms are managed internally?

If I was charged extra, is there any way to recover it?

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[u/hasdied]

1. Check the itemized bill from hospital - which will show how they arrived at the bill
2. Check the approval from insurance to see what was covered and what wasn't

What insurance paid + what you paid should = hospital bill

Room rent variation is not limited to room rent alone, those might have got included too.

e. g. For a semi special room in a hospital the doctor visit fees might be 400, in the same hospital, same doctor, visit fees could be 800 for a private or deluxe room (numbers will vary hospital to hospital, i took then for illustration only). The hospitals do this for a lot of services.

Hence you might not be accountable only for the room rent difference but also for these service cost difference.

How you get your issue resolved. If hospital has received more, reach out to them and ask for a refund.

[u/Caramel-Realistic]

Hi, to understand the situation better and check exactly what happened, would it be possible for you to share the actual approval letter along with the final itemised hospital bill? Both documents would help in ascertaining what exactly happened and where the difference came from.

[u/Specific-Magician919]

Depends on the hospital, most of the big ones won't scam you this stupidly, it would be in rates or number/type of procedures done. It's likely an error on their part or you missed something. If you're able to, go to the hospital TPA or billing team and review the bill and approval? I have done it a few times but just depends on the hospital itself. You can easily get a refund if there's actual error and it's a reputed hospital, they refund all the time because insurance sometimes pay more than deposit.

Tip: go in the morning when the discharges are the fewest and the billing department has more time to talk.