GuideEvery way an Indian payer reduces a hospital claim — room caps, pre-auth clocks, PM-JAY, NHCX.Read the guide →

The room upgrade costs more than the room.

Breach the room-rent cap and most Indian policies cut every associated charge in the same ratio. Put your numbers in and see both figures — the one the counter sees, and the one the settlement applies.

The stay

The bill

Pharmacy, consumables and implants are commonly exempt from proportionate reduction — but it varies by contract. Untick to include them.

How the arithmetic works

  1. Ratio. Eligible room rate divided by actual room rate. Eligible ₹4,000 against an actual ₹6,000 gives 66.7%.
  2. Applied per head. That ratio is applied to each associated charge separately, not to the bill total — the exempt heads have to be pulled out first.
  3. The difference is disallowed. Which is why a ₹2,000 nightly gap becomes a one-third reduction across the most expensive lines on the bill.
  4. It is only fixable at admission. Once the stay is complete the number is arithmetic. The only question left is who absorbs it.

Explained further: room rent cap as a ground of rejection · the ₹43,000 worked example