BPJS cost max cost query

[Anglian]

i was wondering what the maximum amount you can get on BPJS, in my case when I went to Pondok Indah hospital I was quoted 45 million for gall stone removal, due problems total cost 82 million, my old pal went to Mayapada hospital, he was quoted 50 million for a hernia op, ended up paying over 150 million, my wife made Enquiries at Mayapada while we were visiting, what if any the maximum allowed for using BPJS, they gave a figure of 30 million coverage after that you pay, so my question is, does BPJS give total medical coverage, or do some hospitals have their own limit, it would be quite awful to end up thinking you are covered only to end up with a huge bill you cannot afford to pay

 

[jstar]

I thought it depended on the type of hospital (A-D) how much they can charge for inpatient treatment and what will be restituted?

 

[dafluff]

There is no maximum, if you chose to be treated as a BPJS patient, within the approved class.

Hospitals often offer upgrades in room quality and those are charged.

 

[Anglian]

I can understand if you upgrade to a V.I.P room the cost of that is down to the patient, but I’m wondering why they have a 30 mil limit

 

[jstar]

That's a number per (type of) medical intervention which has been negotiated* between government and hospitals. And it depends on the class you're in (1-3). So that 30 juta could be 45 and 60 juta for a hernia surgery in the 'better' classes. But if the treatment cost is 80....
NB: that has NO consequence for the patient, treatment etc. is identical.

*In many Western countries, that is the same. But there the mandatory Health Funds negotiate with the hospitals and often not all costs are covered. Then the patient has to pay a part of the total bill as own contribution.

 

[dafluff]

I can understand if you upgrade to a V.I.P room the cost of that is down to the patient, but I’m wondering why they have a 30 mil limit

BPJS operates on a comprehensive list of how much treatment costs for a particular medical issue. That is the maximum they reimburse the hospital. If the patient is a BPJS patient, the hospital can not charge the patient, even if their cost is higher. This is one of the reasons many hospitals do not like BPJS.

 

[Anglian]

BPJS operates on a comprehensive list of how much treatment costs for a particular medical issue. That is the maximum they reimburse the hospital. If the patient is a BPJS patient, the hospital can not charge the patient, even if their cost is higher. This is one of the reasons many hospitals do not like BPJS.

That’s what I thought, so I was very curious why Mayapada was quoting a limit, they do seem very money oriented, I don’t like to ask my friend how his bill went so high, but it seemed a bit steep for a hernia, unless he had some other medical problems

 

[all4ywh]

Yes, the original quote of Rp 50 million seems quite expensive for hernia operation.

4 years ago at the age of 41 years and in "excellent" overall health, I was quoted IDR 20 million by 2 private hospitals in BSD with highly experienced surgeons : RS Medika & Eka Hospital . At that time BPJS would only pay up to IDR 7 million (seven) for the hernia operation so the operation would had needed to be done at a government hospital because I did not have the option to pay the difference of IDR 13 million to have the operation done at 1 of those private hospitals.