Pulling the plug on inflated medical insurance claims, the Armed Forces Medical College (AFMC), Pune has brought out a first-of-its-kind standard treatment guideline that specifies the average treatment cost for 35 common diseases.

In many of the cases, the rates are a fraction of what patients have been claiming from insurance companies.

For instance, AFMC points out that the maximum charges for a caesarean section, one of the most common claims reaching insurance companies, will not exceed Rs 5,525 in a tertiary hospital with more than 100 beds.

The same procedure can also be carried out by spending Rs 393 in a single-doctor managed clinic.

On the other hand, insurance company officials said medical bills claimed by policy-holders touch Rs 40,000 to Rs 50,000 for a caesarean case.

Depending on the size of hospital and the seriousness of the disease, a patient suffering from pneumonia can complete his treatment by paying anything between Rs 360 to Rs 4,280.

Similarly, the total cost of treating Japanese Encephalitis could be in the range of Rs 348 to Rs 31,264, but not more.

Insurance companies said the claims are often five to ten times higher than the AFMC rates.

Insurers said the rates fixed by AFMC seem reasonable when compared with the claims reaching them today.

That’s because the peak rates are not just determined by the number of beds in the hospital but also by the complication of the illness that requires a patient to be admitted to a tertiary hospital.
HEALTH CHECK
The real cost of treating illnesses (Figures in Rs)
Disease Level 1 Level 2 Level 3 Level 4
Diabetes 34,225 35,119 57,027 66,229
Hypertension 4,236 3,909 4,517 23,753
Viral hepatitis 571 840 3,498 17,391
Oral malignancies 189 145 149 24,129
Level 1: Single doctor; 2: 10 to 30 beds; 3: 30 to 100 beds; 4: Above 100
Source: Armed Forces Medical College, Pune

The study was commissioned by the ministry of health and family welfare and the World Health Organisation (WHO).

The data is designed to help companies offering medical insurance improve their financial bottom line.