Subject: Information required under the Right to Information Act 2005

Reimbursement of my Late father's Medical Expenses

This has reference to the hospitalisation expenses incurred on treatment of my late father Sh. ********* ( Ex- Director, Central Farm Machinery Training and Testing Institute - Budni, MP) who was covered under CGHS scheme( token no. **/***, Lifetime, Pensioner).

Last year in June-July'10 he underwent medical treatment in two of the hospitals ( Global Hospital, and National Hospital) in Bhopal in very critical condition which was later diagnosed as 'Esophageal Perforation' - a rare phenomena as per doctors.

Incidentally both of these hospitals were not covered under CGHS approved list of hospitals but were the best available options suggested by the doctors as it was an emergency situation. We had intimated the local CGHS office duly before admitting our father.

Unfortunately, our father could not be saved and ultimately died on 7th July'10 after 20 days of treatment. The total expenditure incurred on his treatment was 5,54,795/-

Upon submitting our bills to Bhopal CGHS office for the reimbursement they rejected our case and harassed us for months and finally rejected the case without assigning any valid reason, whereas earlier they have assured us that some percentage of the expenses will be reimbursed.

When I took up the issue with higher authorities in CGHS Delhi, response came from one Mr. R.Ravi (Director –Ministry of Health and family welfare) wherein he states very clearly that patient can go to any hospital in emergency and claim as per the CGHS rates. He directed some Mr. Brindha also for urgent settlement of claims. (Following is the text from his Mail for your ready reference).

Dear Dr. Brindha: I am forwarding to you an e-mail received from Shri Shashank Jain, Bhopal, regarding the reimbursement claim submitted with reference to the expenditure incurred on the treatment of his father Late Mr. Shikhar Chand Jain in (i) Global Hospital, Bhopal and (ii) National Hospital, Bhopal during the period 17th June, 2009 to 7th July, 2010, in emergency, which seems to have been rejected by CGHS, Bhopal, probably without assigning any reason.

It is the policy of the CGHS that a patient can go to any hospital in emergency and claim reimbursement as per CGHS rates.  In the case of Shri Jain, the only thing that has been done before rejection of the claim is harassment meted out to the family members who were pursuing the reimbursement claim.

If the treatment taken by Late Shri Shikhar Chand Jain was in emergency, then it goes without saying that reimbursement as per package rate for the treatment taken is to be made.   I would, therefore, be grateful if you could have the claim settled urgently without any delay under intimation to the Ministry.

Particulars of information required: As per list mentioned below

On what grounds our claim was rejected? The documentary proof of the rejection with reasons?

1) Who are the persons with whom our case was pending from the date of receiving to till date?

2) The reason CGHS top management did not respond even after getting clear directions from Mr.R.Ravi (Director –Health and family welfare) from the ministry.

3) What actions will be taken against all these people?

4) By when we will be getting our claim settlement? A clear cut dead line with weekly intimation of the updates till the settlement of the case.