The insurer paid, just not the full amount. Deductions on room rent proportionality, non-medical items and package rates are the three that recur — and two of them are frequently reversible.
Short payment is quieter than rejection and costs hospitals more in aggregate, because it is rarely contested. The money arrives, someone ticks the claim off, and a deduction of eighteen or forty thousand disappears into the write-off column.Three deduction types account for most of it.1. Proportionate deduction on room rentThe patient occupied a room above the category the policy allows, so the insurer scales down not just the room charge but every associated charge — surgeon's fee, OT, investigations — in the same proportion.This is the deduction most worth examining, because it is applied far more widely than it should be:Was the room actually above entitlement? Check the policy's room category definition, not the room tariff. Many policies cap by category (single private room) rather than by rupees.Was a room of the entitled category available? If the hospital had no room in the entitled category and documented that at admission, proportionate deduction on that basis is arguable.Is the policy actually one that permits it? A significant number of policies sold in the last few years do not carry a proportionate deduction clause at all. Insurers apply it anyway. Ask for the clause, by number.Were non-scalable heads scaled anyway? Pharmacy, implants and consumables are not proportionate to room category and should not be reduced on that ground.2. Non-medical itemsGloves, syringes, administration charges, documentation charges. IRDAI publishes a list of items that are not payable, and insurers deduct against it.Two things are worth checking. First, whether the item is genuinely on the list or has simply been assumed onto it — insurers routinely deduct items that are payable when used in the course of a procedure. Second, whether your billing narration is doing you harm. An item billed as "consumables" gets deducted; the same item billed by name against the procedure often does not. This is the cheapest fix in the whole article and it is a billing-desk change, not a recovery exercise.3. Package rate applied after the factThe insurer settles at a package rate you never agreed to, or at a rate from a tariff agreement that has since been revised. Pull the signed tariff and the effective date. If the admission falls after a revision the insurer has not loaded, that is a straightforward correction — and it is usually affecting every claim you have filed since the revision, not just this one.How to raise itA short payment is contested as a reconciliation, not a grievance, at least to begin with. Send a line-by-line statement: billed amount, approved amount, settled amount, deduction, and your ground for each deduction. One table. Insurers respond to that far better than to a letter.Where the deduction stands on a policy clause, ask for the clause number. Where it stands on a tariff, ask for the version and effective date. Where it stands on the non-payable list, ask which item number. In each case you are asking them to commit to a specific basis, and a surprising proportion of deductions do not survive that question.The number that should worry youTake your settled claims for one quarter and total the difference between approved and received. Most hospitals we work with have never calculated it. It is generally larger than they expect, and unlike rejections, nobody in the organisation is watching it.If you want a view of what is recoverable, upload a few short-paid files and our desk will come back on each one.