Charging the Big Dollar for Medical Services: Bali

Having your body suffer an ailment, no matter what it is, in Bali will cost you big bucks and of that you can be assured. There seems to be an association with westerners thought as of being rich and stranded with an illness being a dead set target for the medical profession to charge whatever they like for services rendered. Unfortunately, there isn’t much you can do about it except let your wallet suffer the same dilemma as you!. That is unless you have insurance. But even then, you still have to pay up front and claim later. Here is an article about a Bulgarian man who fell prey to just this.

Exorbitant ‘foreigner’ medical charges discourage tourist

Bulgarian Veselin Ognyanov Yankov arrived in Bali with an exhilarating sense of anticipation. The idyllic beaches, friendly natives and rich culture would embrace and refresh his body, he thought.

Moreover, the vacation would provide him an opportunity to hone his skills in esoteric martial arts at its birthplace, Denpasar.

For years, he had practiced Sandhi Murti, which combines Balinese traditional martial arts with Hindu and pre-Hindu supernatural teachings. A personal audience with Sandhi Murti’s founder and supreme teacher would surely refresh his soul, Yankov believed.

Yankov enjoyed the trip to the beaches. He enjoyed the harsh training with the Balinese disciples of Sandhi Murti. On top of that, he truly enjoyed the evenings he spent with I Gusti Ngurah Harta, the supreme teacher of Sandhi Murti.

Everything went well for him until his stomach gave him a trip he would never forget.

“He felt an excruciating pain in his stomach. Apparently, something was wrong with his digestive tract. He needed surgery,” Harta said.

Yankov wanted to fly to Singapore for the surgery, but the Sandhi Murti master recommended that he stay at a local private hospital.

The Surya Husadha International Hospital (SHIH) provided excellent services at a cheaper price than hospitals in Singapore, Harta said.

“A staffer at SHIH estimated that the surgery and follow-up treatment would cost somewhere between 68 million and 100 million rupiahs,” Harta added.

Yankov followed the teacher’s advice. Accompanied by other Bulgarian disciples of Sandhi Murti — some of whom were medical doctors — Yankov checked into the SHIH on April 10.

The surgery was a success. The follow-up treatment was fine. Everything went as expected — but the bill.

On April 16, Yankov received the provisional medical bill, which amounted to over Rp 200 million.

The higher-than-expected bill shocked Yankov and his Bulgarian friends. Moreover, it also angered his medical insurance company.
For Ngurah Harta, it was a slap in the face.

“I am the person who advised him to go there, and now I am going to lose my face in front of my students,” Harta said.

SHIH division manager Samuel P. Hardianto justified the bill, citing medical complications and expensive medication as the causes.

“There were medical complications and we have also used the best drugs available in treating the patient,” he said.

The ensuing negotiation between Yankov’s friends and the hospital failed to reach a satisfactory agreement. As Yankov recovered from the operation, the SHIH and the 25,000-member Sandhi Murti was on a collision course over his medical bill.

A close examination over the bill revealed that the SHIH had indeed charged Yankov at a much higher price than it would a local patient.

A staffer at the SHIH confirmed that the hospital had a different pricing policy between locals and foreigners: Harga Asing (foreign price) and Harga Lokal, which was applied to Balinese and other Indonesian patients.

For instance, for a foreign patient, the SHIH charges Rp 8 million for a CT scan on the lower and upper abdomen. A local patient would only be charged Rp 3 million for a similar service.

However, the SHIH’s Harga Lokal is still higher than those charged at several neighboring hospitals.

For example, the Prima Medika hospital charges Rp 2.1 million for a similar CT scan, and the International Wing of the Sanglah Central Hospital charges Rp 1.3 million.

Moreover, the fees for specialist consultations on Yankov’s bill ranged from Rp 700,000 to Rp 2.1 million. An Indonesian patient would have paid much less — somewhere between Rp 100,000 and Rp 500,000 for consultation fees.

Anik Sandi, a customer service officer at Sanglah’s International Wing, revealed that charging a higher price to patients who are foreign visitors was accepted practice among private hospitals in Indonesia.

“A similar policy is also implemented by hospitals in Western countries,” she said.

The reason behind the policy, she added, had a lot to do with the fact that the health sector was still heavily subsidized by the government.

“The subsidy comes from the tax. Foreign visitors do not pay any taxes here, so they aren’t entitled to the subsidized prices of health care services,” she said.

Following that logic, foreigners who held a temporary resident visa and were working in Indonesia were entitled to Harga Lokal because they paid local taxes.

“And that’s precisely our policy here at Sanglah. Show us your KITAS (temporary resident card) and we will give you Harga Lokal,” Anik added.

Unfortunately, the government has not issued any regulations or legislation on pricing policy at hospitals across the nation, including on Harga Asing.

“The accepted consensus is that we charge (foreign visitors) twice what we charge the locals. More than that is simply exorbitant,” she stated.

From the charges that appeared on Yankov’s hospital bill, it is clear that for certain services, the SHIH had charged its foreign-visitor patient more than twice the local price.

By April 19, Yankov had completed his treatment, and his medical bill had swelled to Rp 254 million. His insurance would cover a large portion of the bill — around Rp 180 million. But the rest was Yankov’s responsibility.

The SHIH refused to release Yankov until he had settled the bill.

This was the last straw for Sandhi Murti. That afternoon, dozens of Sandhi Murti disciples stormed the hospital to “release” Yankov. Meanwhile, around 100 members flocked the Sandhi Murti headquarters in Panjer, awaiting instructions from Ngurah Harta.

After a tense standoff, the hospital reluctantly discharged Yankov.

“We have secured a letter from the patient stating that he will pay the rest of the bill. Although the letter didn’t state when he would do so,” SHIH division manager Samuel said.

For Harta, the incident left him with one burning question: “Are we really serious about inviting foreign visitors back to Bali?”

That evening, Yankov departed Bali for Bulgaria. He didn’t have plans to visit Bali in the near future.

The holiday in paradise had left him exhausted, psychologically as well as financially.

— I Wayan Juniartha