Non-payable items in health insurance: how to bill them without losing the claim
Gloves, masks, admission kits and other consumables are often deducted. Here is how hospitals can bill them in a way that holds up.
Many health policies follow IRDAI's list of non-medical expenses, which says certain items are not paid separately. When a hospital bills them as separate lines, they are cut from the claim, and the patient is asked to pay the difference at discharge.
Items often deducted
- Personal care items such as toiletries, slippers and combs.
- Admission kits, diet charges beyond the policy limit and attendant charges.
- Gloves, masks, caps and other protective items when billed one by one.
- Registration, documentation and medical record charges.
Subsumed, not free
Several of these costs are meant to be part of room charges, procedure charges or package rates, not separate items. Agree with each payer how they should appear, and bill the same way every time.
Practical steps
- Map each consumable in your billing master to a payable head or a package.
- Tell patients early, at admission, which items their policy will not pay.
- Check the final bill against the approved amount and the payer's rate card before discharge.
- Keep each payer's agreed tariff in one place, so billing staff do not have to remember it.
Check the bill against the rate card
Ekline Claims compares the final bill with the rate card mapped to that insurer and flags items that are likely to be cut, so they can be fixed or explained before the file is sent.
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