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.

On the other hand, parallel audits and in-depth analysis of other health insurance schemes that were conducted showed that below 30 years of age, cases of uterus removal or hysterectomy surgeries are very minimal. Jagannathan added that 1.5 lakh women below the age of 35 years have availed general health insurance cover. Out of these, just 7 women, below the age of 35 had undergone uterus removal on account of trauma which were mainly due to accidents. A policy-holder by the name Meena Kumari, had to undergo uterus removal on account of accidental trauma, but already had a child which is a God saving grace for her family. But like her there are many such women who have lost chances of child-bearing on account of fraudulent activities by certain hospitals for their personal gains.

Source-Medindia
SAM