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How to Steal from Patients....
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Kwanini
#1 Posted : Thursday, July 07, 2011 10:31:25 AM
Rank: Member

Joined: 1/28/2009
Posts: 353
Location: Cloud
Hi, any experiences out there on makor hospitals in Nairobi defrauding patients - especially those admitted through false/double/non administered drugs billing? Was surprised in encountering the case ..where the issue was raised it was blamed on software error...the insurance chaps were able to deal with the case and the final bill was reduced by a massive 35%!
"For i am the master and the captain of my fate"
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Robinhood
#2 Posted : Thursday, July 07, 2011 11:56:36 AM
Rank: Elder

Joined: 12/11/2008
Posts: 2,306
@Kwanini, this hospital must have been amateurish. I assure you that hospitals do this all the time. They request unnecessary tests, repeat tests, unnecessary drugs, procedures Etc. Only insurance companies can pick some of these things from a bill. Many unsuspecting patients just pay and go home.
Great men are not always wise, neither do the aged understand judgement...
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Djinn
#3 Posted : Thursday, July 07, 2011 1:17:23 PM
Rank: Elder

Joined: 11/13/2008
Posts: 1,565
I've always suspected some hospitals of doing this - not the unnecessary tests - rather billing for tests that have not been done. If you have some cover from an MIP, more so OP cover - then this eats into your benefits. You might visit a hospital four times for OP then be shocked on the fifth visit when the MIP says you have used up your cover.

I think there should be a policy where the person covered is privy to what the costs are - all the way from consultation, pharmacy, lab, radiology, etc...
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Burning Spear
#4 Posted : Thursday, July 07, 2011 3:44:58 PM
Rank: Veteran

Joined: 7/22/2008
Posts: 1,139
Djinn wrote:
I've always suspected some hospitals of doing this - not the unnecessary tests - rather billing for tests that have not been done. If you have some cover from an MIP, more so OP cover - then this eats into your benefits. You might visit a hospital four times for OP then be shocked on the fifth visit when the MIP says you have used up your cover.

I think there should be a policy where the person covered is privy to what the costs are - all the way from consultation, pharmacy, lab, radiology, etc...



I can confirm that the patient has the right of information and can request the invoices before they are sent to the insurer.
Moreover,one is not supposed to sign the invoices before all the services are given but you will find most hospitals advise the ignorant customers to sign before services are given.
"You're not supposed to be so blind with patriotism that you can't face reality. Wrong is wrong, no matter who says it". Malcolm X
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dossy7
#5 Posted : Thursday, July 07, 2011 3:49:30 PM
Rank: Elder

Joined: 12/9/2009
Posts: 1,493
Location: Nairobi
One funny thing is whenever u visit the hospital with something like a common cold they prescribe close to 10 different medicines.
Do we really need all those meds or is just a ploy to exhaust your cover?
Kenya ni yetu sisi sote
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McReggae
#6 Posted : Thursday, July 07, 2011 3:59:48 PM
Rank: Elder

Joined: 6/17/2008
Posts: 23,365
Location: Nairobi
Burning Spear wrote:
Djinn wrote:
I've always suspected some hospitals of doing this - not the unnecessary tests - rather billing for tests that have not been done. If you have some cover from an MIP, more so OP cover - then this eats into your benefits. You might visit a hospital four times for OP then be shocked on the fifth visit when the MIP says you have used up your cover.

I think there should be a policy where the person covered is privy to what the costs are - all the way from consultation, pharmacy, lab, radiology, etc...



I can confirm that the patient has the right of information and can request the invoices before they are sent to the insurer.
Moreover,one is not supposed to sign the invoices before all the services are given but you will find most hospitals advise the ignorant customers to sign before services are given.


Seconded, mostly it is cause of the ignorance of the patients who sometimes don't care much coz the insurance shall pay!!!!
..."Wewe ni mtu mdogo sana....na mwenye amekuandika pia ni mtu mdogo sana!".
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Forester
#7 Posted : Thursday, July 07, 2011 5:11:37 PM
Rank: Member

Joined: 12/7/2010
Posts: 520
Location: Epicentre - Ngamia 1
McReggae wrote:
Burning Spear wrote:
Djinn wrote:
I've always suspected some hospitals of doing this - not the unnecessary tests - rather billing for tests that have not been done. If you have some cover from an MIP, more so OP cover - then this eats into your benefits. You might visit a hospital four times for OP then be shocked on the fifth visit when the MIP says you have used up your cover.

I think there should be a policy where the person covered is privy to what the costs are - all the way from consultation, pharmacy, lab, radiology, etc...



I can confirm that the patient has the right of information and can request the invoices before they are sent to the insurer.
Moreover,one is not supposed to sign the invoices before all the services are given but you will find most hospitals advise the ignorant customers to sign before services are given.


Seconded, mostly it is cause of the ignorance of the patients who sometimes don't care much coz the insurance shall pay!!!!


& once the patient doesn't check - this ends up exhausting their cover limits then one day when kuna emergency they're told 'You've exhausted cover limt & need to pay out of pocket.Wololo!
Build your own dreams, or someone else will hire you to build theirs - Farrah Gray.
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Kwanini
#8 Posted : Tuesday, July 12, 2011 12:06:42 PM
Rank: Member

Joined: 1/28/2009
Posts: 353
Location: Cloud
$urpri$ed another thread on madam Getrude$ ha$ come up el$ewhere! Ethic$ i$ $omething they really need to relook at. Wa$ lucky i had an inqui$itive friend who dabble$ in drug$ and wa$ able to highlight " impo$$ible" do$age$ and double entrie$. Any way don't we all learn $omething every day ?
"For i am the master and the captain of my fate"
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