Rs 75,000 for normal delivery, Rs 12,000 for angiography: Maharashtra caps prices of procedures at all private hospitals

Mumbai: In a move that has drawn a strong reaction from the hospitals across the state, the Maharashtra government has gone ahead and put a price cap on the prices of a series of medical procedures for private and charitable hospitals. The move which has been done to prevent any kind of overcharging during the COVID-19 pandemic, has met a strong reaction from the many of the top private hospitals in Mumbai which stated that the price of some of the procedures is even less than the cost incurred by them.

The government, however, has been firm on its stand that noting that a large number grievances of the exorbitant amount of money being charged by the Healthcare Providers which is causing hardship in the light of the pandemic. 

With this, there is a full cap on the prices to be charged for a various list of procedures. The maximum price of a normal delivery ( with baby care) has been set to Rs 75,000 while that of a C-section has been set to Rs 86,250. The price of angiography has been capped to Rs 12,000 while that of an angioplasty (excluding cost of balloon, guidewire and catheter) has been set to Rs 1,20,000. The list of procedures and prices are attached below 

The notification, that has been approved by the governor, refers to various acts including the Epidemic Diseases Act, 1897, Epidemic Diseases Act, 1897, Maharashtra Essential service Maintenance (Amendment) Act, 2011, Mumbai Nursing Home Registration (Amendment) Act 2006, and alludes to the fact that the State of Maharashtra is threatened with the spread of Covid-19 epidemic, already declared as a pandemic by the World Health Organization;

It also noted that various charitable hospitals are legally required to hold 10% of its beds to providing treatment free of cost and also that many many Healthcare Providers in Mumbai, Thane, Navi Mumbai, Panvel and Pune have specific agreements/ understanding with General Insurance Public Sector Associations (GIPSA) as a member of Preferred Private Network (PPN) regarding rates of various treatment packages while some Healthcare Providers in Mumbai are not part of GIPSA- PPN;

Besides, many Healthcare Providers situated in State of Maharashtra other than those situated in Mumbai, Thane, Navi Mumbai, Panvel and Pune are not part of GIPSA- PPN and have their own specific agreements/ understanding with various Third Party Administrators (TPA) regarding rates of various treatment packages and each Healthcare Provider may have different rates for same treatment packages among various TPAs operating in that Healthcare Provider institution

It also noted expenses towards the treatment of persons insured for IRDA approved healthcare products treated in GIPSA- PPN or network of hospitals empanelled by various TPAs at specific package rates agreed by them are borne by the insurer.

"However, the persons who are not covered by any health insurance product or who have exhausted their health insurance covers are being charged exorbitantly causing hardship to the public in general during the pandemic situation," the notification stated 

In order to redress the grievances regarding the exorbitant amount of money charged by Healthcare Providers from patients who are not covered by any health insurance product or who have exhausted their health insurance cover, all the Healthcare Providers functioning in the State of Maharashtra are hereby directed that :

1) The Charitable Trusts registered under the provisions of the B.P.T. Act which are running Charitable Hospitals, including nursing home or maternity home, dispensaries or any other center for medical relief shall make all possible efforts to discharge their obligations as per provisions of section 41AA of the B.P.T. Act before applying any changes to any eligible patient. 

2) The Healthcare Providers situated in Mumbai, Pune, Navi Mumbai, Panvel, Thane having agreements/ understanding as a member of GIPSA- PPN are prohibited from charging more amount than that applicable to lowest bed category irrespective of the availability of a bed in the lowest category agreed to in their respective GIPSA-PPN agreement/ understanding. 

3) The Healthcare Providers in Mumbai which are not part of GIPSA- PPN shall not charge for all bed categories more than the package rates prescribed in Annexure- A appended to this notification.

4) Healthcare Providers have agreements /understandings with various TPAs pertaining to package rates for different treatments. A health care provider having different package rates for similar treatment with different TPAs shall provide the treatment at the lowest package rate prevailing amongst different TPAS in its facility. 

 5) Items/ services including Intraocular Lenses (IOL), pacemaker, Ortho prosthesis, stents, staplers, Guide-wire Catheter, balloon, medical implants, consumables, PPE kit etc. which are not part of GIPSA- PPN or TPA package rates shall not be charged more than 10 percent markup on Net Procurement cost incurred.

6) The Healthcare Providers shall display at prominent place details of all types of charges prescribed as above. It is the duty of the concerned Healthcare Provider to explain to the patient/ relatives of the patient details of all types of charges.

To read the full notification and check out the list of charges, click on the following link below.

 https://medicaldialogues.in/pdf_upload/pdf_upload-128160.pdf