Unethical Practices by Some Hospitals for Claiming Insurance Meena Kumari,
at 25 years of age, had never expected that in her life she would have to
undergo a surgery which would have a major impact on her life. Last year,
she had consulted a Chennai based private hospital for irregular menstrual
cycle. It was diagnosed by this private hospital as small fibroid in her
uterus and subsequently underwent hysterectomy to get her uterus removed. As
this individual was covered by the government employees’ health insurance
scheme, a claim amounting to Rs 40,000/ - prepared by the hospital was sent
to the insurance company for re-imbursement.

Upon further investigations by an expert panel comprising of doctors from an
insurance company, this surgery has been deemed as unnecessary and
unjustified.

More than 30% of the hysterectomies done under the insurance scheme are
unwarranted not only by the medical fraternity and across insurance
companies but also by the senior medical practitioners. This has rendered
several women as medically unfit to conceive, thereby complicating the
social lives of such families and this classic example is strongly
illustrative of violation of medical ethics.

An analytical study of the records available across insurance companies
depict that under the government employees’ health scheme, approximately 540
ladies in the age group of 25-35, members exceeding 100 in the age range
from 20-30 years, had undergone surgeries pertaining to either removal of
uterus or ovaries.

V Jagannathan, Chairman of Star Health and Allied Insurance, has conducted
numerous marathon meetings with hospitals, warning them against medical
malpractices and quoted examples by citing numerous instances. For example,
when one of the patients was contacted by the Insurance Company, the patient
replied that she had agreed to undergo surgery just because she was informed
that it could turn cancerous. In fact, surgery is not the only remedy for
irregular menstrual cycle in women. It is not a necessity that many young
women should have to undergo this ordeal. It can simply be treated by
administration of medications to regularize their periods and added that
further examination in such women revealed that there was absolutely no
family history or any ailment pertaining to their reproductive system. Just
recently, two private hospitals in Nagercoil and Kanyakumari were
“blacklisted” in connection with exorbitant expenses from the beneficiaries
of the Kalaignar health insurance scheme implemented by the government of
Tamil Nadu, India.

Source: medindia


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