To avoid being unfairly charged, bring your hospital bill up to date by tweaking it

Kenyans need to be empowered enough to avoid being unfairly charged by bringing their hospital bill up to date through tweaking it.  Claims of bills inflation were emerging everywhere with hospitals unfairly generating revenue from patients.
We need to figure out as a country whether we can continue on this trajectory.  When one sees the exploitation of patients going on in our private hospitals according to recent social media postings  This cannot be allowed to continue since Kenyan households spent over a tenth of their budget on health care.
One way out would be to bring your hospital bill up to date by tweaking it.  Whether it means bringing up-to-date or up-to-speed, these are some DIY ‘Do it yourself’  without necessarily appearing to be the bad boy.  These tips form our topic for today.
Why up to date and up to speed?  Because you as the client/patient must show genuine concern for what you are paying for and never be behind with your bills.  One must be able to get the most for what they pay. This is a good principle everywhere, but it does not seem to matter in the hospital until it is too late or is it ‘too embarrassing’ to act.  Infact, many Kenyans do not know how to deal with the hospital staff in a manner that is less upsetting when such issues arise.

But what is the solution? I have tried to scratch the surface albeit with a very soft feather for you, no crawls this time.

My very presence of mind has been aroused by a trending thread by Owaahh on the commercialization of our private hospitals.  It was a follow up on another one ‘so it begins…’  A lot of complaints characterize these thread.  Kenyans, it seems we’re ready and willing to volunteer the evidence on these dirty tricks to create a provider induced demand and milk the client dry.  It is becoming clear that there are some hospitals that are not up to real business but chasing deals, with insurance companies, and stealing from helpless clients.

Media reports indicated that Nakuru team of Nairobi Women’s Hospital through their Whatsapp group going by the name Nakuru Hyrax leaked screenshots WhatsApp chats clearly showed that staff were under pressure to increase patient numbers one way or the other.  Such strategies included: “start looking for referrals”, “Not to miss any opportunity (to admit) and “be very vigilant in Casualty”.

The hospital was at pains to refute the allegations. The outcry led to the Association of Kenya Insurers (AKI) removed the facility from their list of approved service providers. Advising their clients that insurers would no longer honor bills from Nairobi Women’s Hospital (NWH). Several corporate clients including Kenya Revenue Authority (KRA) suspended their memorandums to have their staff attend the NWH facilities.

There was very little way-forward provided though.  Discussion on this subject on some members-only social walls were getting longer and longer with no relenting.  However, when this author shared the same thread to a Whatsapp UASU (University Staff Academic Union) chapter there was a single comment one week later now.  Mark you it’s members we could say form the think tank in terms of academia and policy for this country.  What could be happening to this dear country of ours?

Should it be taken to mean helplessness or some form of fatigue?  Who will address this soko huru ‘free enterprise’ stuff?  Someone said there was a consumer watch, an ombudsman in Kenya.

Nothing is worse than having to meet these expenses from out-of-pocket (even with a remote possibility of claiming for reimbursement).  Imagine having to fundraise for some of these hospitals ‘ read trading floors’.  Paying ‘an arm and a leg’ for provider-induced demand services you did not need in the first place.

Someone wrote in one of the walls – Interestingly public servants and state officers who have some form of medical insurance keep brandishing with pride and inflated ego whenever they approach the hospital’s reception desk … not knowing what awaits them.  Maybe that is why this debate will also fall on deaf ears just like many other consumer complaints.

I bet the medical staff who shared the stuff have been reprimanded and branded traitors by now,  but there will be no public outcry.  There should have been by now anyway!  This is a matter of economic justice and morality.  Just because I can pay (or have medical cover for that matter), I should be fairly charged not overcharged, exploited and defrauded.

As the saying goes, ‘You are one illness away from financial ruin’.  The Kenya government hopes to reduce out-of-pocket costs from 26 percent to 12 percent in 2022.  According to Dr. Githinji Gitahi of Amref ‘… universal health coverage meant that those left behind are brought to the same level as those who can afford to pay for health services’.
One in five Kenyans who get sick every month, a fraction of them (16 percent) failed to seek medical care due to financial difficulties.  Another four out of 10 found it tough, ended up selling their belongings or took loans to pay medical bills, but in the process, nearly 2.6 million annually were pushed into poverty and destitution by high healthcare bills either directly or indirectly according to Kenya Household Health Expenditure 2013.
Let us come back to the main reason for this article.  Why do Kenyans bargain on everything else except one of the most costly expenditures – a medical bill?  Thinking of this, I am reminded of the word tweak which means  ‘making fine adjustments to it’.  An even better definition Cambridge dictionary ‘…to change something slightly, especially in order to make it more correct, …’  No hospital bill is cast on stone if only we care enough to tweak it.  In fact, insist it is tweaked until it cannot be done any further.  It is your right as the payer to get a correct, fair deal. In short get value for money.
What great satisfaction there could be in knowing you could query your medical bill! Here are some Do it Yourself (DIY) tips you could adopt as a Kenyan.  I say ‘as a Kenyan’ here because I know how powerful information is, but more so if one feels empowered to take action based on the information. Dr. Gitahi during the fifth Nation Leadership Forum held in July 2018 summarized this very aptly – Purchase healthcare in a strategic manner to avoid waste. Ask what do we want to purchase, how do we purchase it, and who do we purchase it from? To get more value for money.
It is good practice to bring your hospital bill up to date by interrogating it, scrutinizing it and even petitioning it. Medical bills are unpredictable and difficult to factor into regular household spending.  This means that out of pocket [in simple terms cash payment] is a more flawed model of paying for health services, worse still because it overburdens those with little disposable income, in turn becoming poorer and less healthy.

(courtesy of developer)

Unfortunately, many patients, relatives, and friends do not feel empowered enough to interrogate the hospital bill. Every day they know they were being credited but they dare not ask lest its too much.  A majority of them request for it upon discharge or demise of their loved one.  I will say this for my country Kenya that it is at this point that they take off in a huff to start looking for funds from God knows where. Some to fundraise, to seek a waiver, provide surety etc.  A few have been known to abscond.

It would be more prudent to ask to go through your bill on a day to day basis, scrutinize it when the memory is still fresh about consumables, procedures, and orders that had been made.  Inquire from the regular staff the meanings of items in the bill.  You will be surprised that even some fellow patients might have some clue, especially those who have been there longer. There is often this caretaker who have seen it all!

In one private hospital, the surgical pack was meant for those patients in the surgical wing while those from the medical unit were charged a medical pack.  It contained most of the non-pharmaceutical consumables, toiletries needs. It was not unusual for the same patient to be charged both. While this error (whether deliberate or not) was obvious to the staff they will wait for you or someone else to bring it up, what if they don’t? The patient pays.

Kenyans were upset by recent revelations by EACC in a 40-page report on MOH after a systems audit aimed to seal loopholes of corruption.  The audit was launched in March 2017 and the report released on 17th August 2018 by Arc. Bishop Wabukala to then CS Health Cicely Kariuki. Available

It unearthed disparities of cost.  Cost of say Panadol 500mg varied from 10bob in Nairobi to 400 in Lodwar.  An anti-ulcer 500mg drug KEMSA Ksh840, Ksh1300 at coast county referral, Ksh2400 Nakuru referral.

An item that costs Ksh 700 at KEMSA level sold/ charged at Ksh 35,000 by hospitals.  Health facilities apply different price mark-ups ranging from 10-30 percent for medicines and other supplies.

It also showed how hospitals were fleecing insurance providers.  Mark you this audit was mainly on public health institutions.

Mind to know how your bill was computed.  No matter your current financial or insured status.  Who knows, in the unforeseen future, your status can change.  It’s arrogant (or do we say ignorant) to just sign off your bill without an iota of scrutiny.  As one person said ‘don’t be too ill to care to know what is happening to your bill, it is equally sick’ Maybe that was why we say one has a clean bill of health, health is wealth because, without your health, you have no quality of life.  Your health and your bill are somehow related. Refer to the repeated bill above.

It was a general observation that the billers took advantage of the insured client since they were likely to be less keen to scrutinize (or cared less).  But the same precaution applies. It is good to spare something on your side of the insurance just in case several months down the line the amount remaining might not meet your next admission. Remember that nothing is really free, someone somewhere is paying for it.  Making a saving is always good practice even when you are a corporate client.

At times a nagging question does wonders – by the way, how much will I be charged for that?  How necessary is it? Can we do without it?  What would be the effect? A battery of tests done on most patients were unnecessary.  There is also the phenomenon called physician-induced demand whereby the demand for more and more unnecessary interventions are done to those who could afford it.

Even simple orders from your side do matter.  Patients have ended up making orders for items which in actual fact they were entitled to as covered by the daily bed charges. Imagine failing to circle large meal in the menu only for you to end up sourcing for more at an extra expense.  Asking the saloon to do a complete pedicure/manicure when in fact this was not part of common habits.

Lastly, if you agree on the content sign off the bill if you don’t let them redo it.  Take a photo scan of it and share it with someone who might be helpful in the future.

Most Kenyans were not exposed to matters medical bill manenos (medical billing stuff) from an early age like the developed countries. The following little rhyme illustrates how this happens elsewhere.

Miss Polly

Miss Polly had a dolly who was sick, sick, she called for the doctor to be quick, quick …. The doctor came with his bag and his hat, and he knocked at the door with a rhat tat tat.  He looked at the dolly and shook his head. He said, ‘Miss Polly put her straight to bed’.  He wrote on a paper for a bill,  ‘I will be back in the morning with the bill’… [Courtesy of Hoopla kidz]

Never mind: Miss Polly was a pre-schooler, Dolly was actually a doll.  Online E.L actually responded thus ‘So she called the doctor for a doll?, besides dolls do not get ill, they are neither alive or dead’  J.G responded, WHATEVER HAPPENED TO THE BILL?

Miss Polly settings could be were different from Kenyan’s.  More likely drawn from a developed country.  But it was good to let our children participate in these matters, show them a bill, empower them to know how to assert themselves in querying items on an invoice/bill.

One of my ardent followers shared the initial link with a caption ‘You know you are a Kenyan when you are ‘too ill’ and equally worried about your hospital bill, which is equally sick.  Or when you get the bill and run to do some Harambee ‘fundraise’.  When you remain on the CR (Credit Risk) radar of the hospital even though you have been paying and are able to pay cash.

When the medical bill has pchu!  It requires your interrogation.  Why do we say a clean bill of health anyway? This is what you ought you know. Let them know that it is good stewardship to save on insurance from early childhood. Why it was not in their interest to show a do not care attitude towards bills in general.  That it was always good to save on the insurance cover, it could help to give some incentives for those who show such goodwill in the previous year.

World Health Organisation (WHO) Country Representative Kenya Rudi Eggers, explained that universal health coverage (UHC) means that – all people, not only in Kenya, but across the world, have access to basic health services that are of high quality, without suffering financial loss (or having to pay out of their own pockets for healthcare).

Some wikiHow resources are available online on how to negotiate and how to dispute your hospital bill.

Read on universal health care for Kenya.  What should come first the cover or the care? Please follow the Owaahh trending link and welcome again my blog.

If you are a nurse or any other medic I am ready to offer my blog for this, just hit comment below.  I will summarize the feed-backs ethically and dispatch what must be to the relevant readers.


Compleat Nurse


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