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Dulal
15-10-2013, 03:53 PM
A CGHS card holder employee of GUWAHATI, Assam (having GP of Rs. 1900/-) admitted his 17 year old dependent son to a private nursing home with symptom of high fever, body ache, loose motion etc. at 6 p.m. and the patient was discharged next day with an emergency certificate.

As per latest clarification Heads of Departments (HODs) may decide the cases of reimbursement of medical claims in respect of treatment obtained in emergency at private hospital/private nursing home/private clinic subject to item-wise ceiling as per rates prescribed for CGHS beneficiaries without financial limit on the total amount to be reimbursed.
[M.H. & F.W. O.M. No. S-12020/4/97-CGHS(P) dt. 07.03.2000]

The employee has submitted the following bills;
1. Bed Rent-900
2. Resident Doctor Fee-300
3. Bursing Charge-250
4. Bio Merdical waste-150
5. MRD Charge-100
6. IPD Registration Fee-100
7. Investigations Charge-7230
8. Service Charge-170
9. Consultation Fee (Doctor)-1120
Totaling Rs. 11680/-

The investigation tests comprises of
Blood R/E
PF/PV test /PBS for MP
Dangue Test/Typhoid Test
S. Uranium/TSH/LFT/Electrolyte
CER (PAV)
USA w/a

Kindly advice, how to settle the above claims and what are the precribed rates for the charts shown above.

thanks in advance and please help.

sinha_audit
27-11-2013, 09:01 PM
As you have rightly pointed out, reimbursement would be as per CGHS rates for tests and doctor's charges. Cost of medicines purchased will be reimbursed (except in the nature of food items, tonic etc-please consult relevant rules and listings). The bed charges will be limited to the entitlement, i.,e., general ward charges in this case. In special circumstances, if the patient so required to be kept separately (semi-private/private ward), a certificate to this effect is required from the treating specialists.