Insurance Deductions in Patients’ Bills: A Case Study on Tamin Ejtemaei Insurance in Iran

Background: Insurance deductions are not only caused to failure to achieve thepaid costs from the provided services but also are caused to the inefficiency ofhospitals. So, this research was conducted to determine the amounts and reasons ofinsurance deductions in patients’ bills of Tamin Ejtemaei.Methods: This descriptive-practical and retrospective study was conducted in thesecond season of 2012. The statistical population included records of hospitalizedpatients (discharged) covered by Tamin Ejtemaei insurance that was conducted ascensus. The data were collected by using a check list which its validity had beenconfirmed by experts. The collected information was analyzed through the Excellsoftware and descriptive statistics. Information related to the proposed solution wascollected by using group discussion.Results: The amount of applied deductions by Tamin Ejtemaei insuranceorganization was 47408.62 $ (1$ = 12050 Rials). As bills of hospitalized patients’records. The mostly applied deductions were respectively related to equipment ofsurgery-room, the type of bed during hospital stay, and surgeon fees, however, themain part of these deductions was due to the premium (incompatibility between theprice on request and the price of equipment applied for patient) as well asadditional request (not consideration of the authorized tariff) by hospital.Conclusion: The hospital efficiency and care therapy quality can be improved bymore accurate and better perception of the amount and reasons of insurancedeductions and correct management of them.

Keywords:

Insurance , Insurance Deductions , Hospitalization Bill , Hospital