Healthcare costs in India are going up by about 14% every year. Nearly 10 crore people fall into poverty each year because of high medical expenses. That’s why knowing how to read and understand your hospital bills is not just useful – it’s important.
This guide explains the main parts of a medical bill, how the billing process works, and the difference between cashless and reimbursement claims.
What Makes Up Your Hospital Bill in India
Hospital bills are not just about doctor’s fees. They include multiple cost components, and understanding them can help you manage expenses better.
Hospital Charges in Medical Bills
These are costs for your hospital stay, surgeries, tests, or procedures.
- Vary depending on room type (AC, non-AC, private, semi-private).
- Each hospital maintains a tariff chart for transparency.
Treatment Fees in Medical Bills
Covers professional charges for doctors, surgeons, and specialists.
- Also includes the use of operation theatres, labs, and equipment.
Co-pay in Medical Bills
A fixed amount you pay when using certain medical services.
- Example: ₹300 for a doctor visit or ₹100 for a prescription.
- Co-payments don’t reduce your deductible.
Deductibles in Medical Bills
The amount you must pay before your insurance coverage starts.
- Example: If your deductible is ₹1,000, you pay that much before your insurer contributes.
Coinsurance in Medical Bills
The percentage of the bill you share with your insurer.
- Example: If coinsurance is 20% on a ₹10,000 bill, you pay ₹2,000 and insurance covers ₹8,000.
The Medical Billing Process Explained
Understanding how billing works step by step reduces surprises later.
Step 1: Patient Registration
Hospitals record your personal and insurance details.
Step 2: Pre-Authorisation
Insurers confirm policy validity, coverage limits, and applicable co-pays/deductibles.
Step 3: Submission of Medical Documents
Doctors share diagnosis and treatment plans with insurers. Documents usually include:
- Discharge summary
- Test reports and receipts
- Surgeon’s certificate and bills
Step 4: Charge Entry
All services are verified and recorded in the billing system.
Step 5: Claim Submission
Hospitals forward claim forms to your insurer—either online or in paper form.
Step 6: Handling Claim Denials
If a claim is rejected due to missing documents or errors, either the hospital or patient must resubmit.
Step 7: Final Payment Posting
The insurer settles payments with the hospital and shares details with you.
Cashless vs. Reimbursement Claims
When using health insurance, hospital bills are usually handled in two ways: cashless and reimbursement.
Cashless Claims
In a cashless claim, you don’t pay the hospital directly.
- Available only at network hospitals (those tied up with your insurer).
- The hospital sends bills to the insurer for settlement.
- You may still pay for non-covered items (e.g., toiletries, guest meals).
Reimbursement Claims
Here, you first pay out-of-pocket and then claim reimbursement later.
Documents required often include:
- Filled claim form
- Cancelled cheque and ID proof
- Original discharge summary
- Itemised hospital bills and receipts
- Lab reports and prescriptions
- Hospital registration certificate
For more details, see the IRDAI Health Insurance Guidelines.
What Insurance Usually Covers in Your Medical Bills
Most insurance plans cover major medical costs, such as:
- Hospitalisation (in-patient care)
- Pre- and post-hospitalisation expenses (limited days)
- Critical illness treatment
- Ambulance charges in emergencies
- Daycare procedures (like minor surgeries)
- Domiciliary hospitalisation (home treatment if hospitalisation isn’t possible)
What Insurance Excludes from Your Hospital Bills
Not all costs are covered by insurers. Common exclusions include:
- Cosmetic surgeries (unless medically necessary)
- Long-term nursing or rehabilitation care
- Preventive vaccinations (unless stated in policy)
- Nutritional supplements not prescribed by a doctor
- Experimental or unproven treatments
- Non-medical extras (TV, toiletries, guest meals)
- Treatment from unqualified practitioners or family doctors
Why Understanding Your Bills Matters
By knowing how healthcare billing works, you can:
- Avoid unexpected expenses
- Select the right insurance plan
- Keep documents ready for smooth claims
- Reduce out-of-pocket medical costs
Conclusion: Managing Healthcare Bills with Confidence
Medical bills don’t have to be overwhelming. With the right knowledge, you can manage them confidently. At Even, we believe transparency in costs and claims is the first step to stress-free healthcare.
Looking for cashless hospitalisation, upfront pricing, and 24×7 support? Explore Even’s health coverage plans today.
