Kolkata, 22 April (H.S.) -

In a significant move aimed at making healthcare more accessible, the West Bengal Health Regulatory Commission has confirmed that patients undergoing minor surgeries — known as day care surgeries — will now be eligible for mediclaim benefits even without hospital admission.

These short-duration procedures, which typically require only a few hours and do not warrant overnight hospitalization, include surgeries such as cataract removal, foreign body extraction from the eye, piles or fistula operations, and minor tongue procedures. Until now, patients were often forced to be admitted to hospitals solely to fulfill mediclaim eligibility criteria.

At a crucial meeting held with representatives from 11 insurance companies, Commission Chairman Asim Kumar Bandyopadhyay addressed this longstanding loophole. The system for covering day care surgeries has been very opaque. Insurance benefits were previously denied unless there was proof of admission, prompting many private hospitals to falsely admit patients just to claim insurance, said Bandyopadhyay.

Insurance companies attending the meeting assured the Commission that day care surgeries would now be fully brought under health insurance coverage, eliminating the need for unnecessary hospital stays and inflated billing practices.

The meeting, attended by Commission members including Dr. Makhanlal Saha, Vinod Kumar, Secretary Arshad Hussain Warsi, and Dr. Maitreyee Bandyopadhyay, also focused on the inclusion of consumable items such as cotton gauze, surgical masks, gloves, and injection syringes under the mediclaim coverage. These items, previously classified as non-medical and therefore not reimbursed, are essential for surgeries and add significant cost burdens on patients.

“All insurance providers present have agreed to include consumables in their coverage moving forward,” the Chairman confirmed.

Furthermore, the Commission strongly instructed that patients should not be held back in hospitals if their mediclaim approvals are delayed. Disputes between hospitals and insurance administrators, including Third Party Administrators (TPAs), must not affect the patient’s discharge process. “The patient cannot be penalized for system inefficiencies. Hospitals and insurers must sort out issues among themselves,” the Commission asserted.

Hindusthan Samachar / Satya Prakash Singh