Need help, Can you please share approved cost of IMRT by different insurance companies for 28-33 fractions.
I was misled to believe that cash is cheaper compared to Insurance, now it turns out to be other way around. I was told Insurance and cash rates are 220,000/- but by paying in cash I can get 50% discount on PET scan so saving ~11,000/- . Now it turnout to be (as told by this hospital) that Insurance rates are 190,000/- not 220,000/- , 30,000 less compared to cash.
I down loaded CGHS ( Central Govt Health Service) rates, approved IMRT package rate are ~130,000/- only.
I am looking to confirm if Insurance rates are 190,000/- or still lower? There may be variation from one insurer to another, I believe this difference should not be much.
Thanks
( could not argue on technical so.. ) I insisted I can not afford and would like to go for IMRT. That still was not confirmed to me until planning was done.
Govt sector have got no clue and they u have 10 fractions, 30 fractions or 1000 fractions of IMRT:. If it's the word IMRT written they would have the rates as quoted by you.
CGHS have their guidelines and threshold
Army an Navy may have their own
Rajiv Gandhi scheme for the poor ( I think specific for Maharashtra) have their limits
ESIS, air India have their own limits.
In all the above( a top class officer, executive has higher insurance Vs ordinary worker).
In private setup, sky is the limit.
You go to five star hotel...the cost for a coffee may be 500, If u go to Costa coffee it may be 400, if u go to 3 star hotel it may be 200, if u go to simple hotel it may be 50....if u have it on road it may be 10-20 bucks.
In private sector the hospital decides the rate. It's a business for corporates who have invested cores on the machine, who are spending lakhs on its maintenance, insurance, staff, electricity bills are 1-1.5 lakhs etc to run a Linear Accelerator.
The insurance companies may have their Cap...based on what they think is reasonable. If the hospital and insurance have a tie up...they have mutual understanding and rates can fluctuate 0-20%.
Any hospital may have the right to fluctuate their rates.... Up to 10-15% or so.
There are lots of permutations and combinations possible.
Definitely in free enterprise there is no limit on pricing.
But coming to my question:
1) General displeasure around misleading (specially when concerned staff and us had build a trust through a common friend from the Medical field itself and had 5 month of contact before the event), this is one thing least expected. It was general outburst, not looking some specific help with it.
2) About rate, I was looking input from all the people in the forum. Let me be more specific, if someone has 3 Lakh insurance or 3000/- per day room rent limit. in such scenario what is the IMRT package cost hospital offer or insurer approves.
I believe in Bangalore market what Insurer settle with Kiran Mazumdar Shaw / HCG / Manipal Hospital/ Apollo is not going to be vastly different. Even if it different, that' ok it will help us as patient understanding it.
It is more a survey, I hope it is not beyond the mandate of the forum.
I can understand your anguish. But no one can actually give an answer. Also, cost of radiation has no bearing on your insurance. It is your choice purely and package you select. Of two patients with both 3 lakhs mediclaim with room rent limit of 3000 per day, one may opt for IGRT, costing more than 2 lakhs while other may go for simple 3DCRT which may be less than 80k. There is absolutely and absolutely no bearing with insurance limit. The insurance companies may have limits; I am not aware of what those are. You may write a common email to all insurance companies and seek answer; they might tell you. And if you were to ask, how do insurance companies decide which to sanction and which to not, even we do not know. It's because the person who decides fate of insurance being passed is not some qualified person. And there are lots and lots of factors which come into play. For one given patients, if she takes radiation in one hospital, the insurance company may not give even half the amount, while if she were to take it in some other hospital, she might even get full amount. So it also depends on how the insurance company views that hospital and other such factors
Thanks Dr Rohit,
Had this MSW (the person who gave me estimation, that' what it is called in this hospital) not given me any estimation or given correct one I would have gone with insurance and save some money as I had purposely not utilized my insurance in chemo cycles fully.
Anguish is more because the Consultant (Dr) with whom this MSW is attached to in the hospital, I have been consulting him as guide form the beginning of the treatment/surgery on the recommendation of common link (another Radiation Oncologist) and the in-difference shown later on, with out any admission of mistake.
I see insurance discussion is a lengthy topic, will leave that for some other time.
Thanks
Agree fully with Dr. Rohit.