How to check your hospital bill against your health insurance policy

When to check

When	What you have	What to do
At admission	The hospital's estimate	Note the room category and its daily rent. Compare the rent with your policy's room limit.
During the stay	The interim bill (ask the billing desk)	Check the room line and look for items billed separately.
Before discharge	The final itemised bill	Check every line. Raise questions before the final approval request goes to the insurer.
After settlement	The settlement letter	Check each amount disallowed and the clause it cites.

The earlier you check, the easier it is to fix. Before discharge, a wrong line can be corrected in the final approval request. After discharge, it becomes a grievance.

What to check, line by line

Bill line	What to look for
Room rent	The daily rent against your room limit. A costlier room can trigger a proportionate deduction on other room-linked charges. See the room and ICU line in row 8 of the Customer Information Sheet in your policy.
Room-linked charges	Charges the policy pays in the ratio of eligible rent to actual rent, if your room cost more than the limit. See the definition of associated medical expenses in your policy.
Medicines, consumables, implants, diagnostics	Whether they were scaled down because of the room. IRDAI's June 2020 norms kept them out of that cut. See the proportionate deduction clause in your policy.
ICU charges	Whether they were scaled down. The June 2020 norms said they should not be, because ICUs do not come in categories. See the proportionate deduction clause in your policy.
Admission kit, gowns, file or registration charges	Items IRDAI's July 2020 circular placed inside the room, procedure or treatment charge (Lists II, III and IV). See the non-payable items annexure in your policy.
Toiletries, attendant, phone, laundry	Items on List I of IRDAI's July 2020 circular, usually yours to pay unless your policy or an add-on covers them. See the same annexure in your policy.

If you were admitted on a package, ask the desk for the list of what the package includes, and check that nothing inside it is billed again.

IRDAI's May 2024 master circular superseded both the July 2020 circular that carries the non-payable lists (Annexure 6, item 1) and the June 2020 proportionate deduction norms (item 19), without restating either. Policies written under them still carry the lists and the deduction rule in their own wording, and your wording is the contract. Read the non-payable items annexure and the proportionate deduction clause in your own policy.

At discharge

For a cashless claim, the hospital sends the final bill and discharge summary to your insurer or TPA. IRDAI's Master Circular of 29 May 2024 says the insurer must give final discharge authorisation within three hours of receiving that request, and the patient must not be made to wait to be discharged. If a delay past three hours adds to the hospital charges, the insurer pays that amount, not you. Ask the desk to note the time it sent the request.

After settlement

Read the settlement letter. Under IRDAI's September 2024 policyholder master circular, any partial disallowance must come with reasons that cite the specific policy terms. Under IRDAI's 2016 TPA regulations, a TPA letter must show the amounts disallowed and why.
If a cut looks wrong, write to the insurer's grievance officer with your policy and claim numbers and the clause you rely on. The insurer must acknowledge the complaint at once and resolve it within 14 days.
If that does not settle it, register it on IRDAI's Bima Bharosa portal. You can go to the Insurance Ombudsman within one year once the insurer rejects your complaint, fails to reply within a month, or replies in a way you do not accept.

Have a hospital stay coming up? Send your policy on WhatsApp and a person checks it with you before discharge.

Questions

What is a hospital bill audit?

It means reading the itemised bill line by line against your policy and IRDAI's rules, to find charges your policy should pay but were left for you, and charges that should not appear as separate lines. You can do it yourself with your policy wording and the steps on this page.

When should I check the hospital bill?

During the stay, from the interim bill, and again from the final itemised bill before discharge. A mistake found before discharge can be fixed in the final approval request. After discharge it becomes a grievance with the insurer.

Which bill items does health insurance usually not pay?

Items on List I of IRDAI's July 2020 annexure, such as toiletries, attendant charges, phone and laundry, unless your policy or an add-on covers them. Lists II, III and IV are items that belong inside the room, procedure or treatment charge and should not be billed separately.

What if the insurer deducted an amount I don't agree with?

Read the settlement letter first. Under IRDAI's September 2024 policyholder master circular, a partial disallowance must give reasons that cite the policy terms. Write to the insurer's grievance officer, who must reply within 14 days, and go to the Insurance Ombudsman within one year if the reply does not settle it.