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Dear Sir/Madam,

My father passed away on 5th November 2014 due to liver and heart problems. At that time, I admitted my father to SUM Hospital in Odisha, which is an ESI tie-up medical facility. My father was also under the ESI Scheme. I have medical bills and all necessary documents. Can anyone help me with how to claim reimbursement for these expenses? Is there a possibility of receiving assistance from ESI?

Please assist me, as I am currently facing significant financial challenges. Your prompt response and support would be greatly appreciated.

Thank you.

From India, Bangalore
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Mr. Goutham, you have all medical bills and all documents. You are eligible for medical reimbursement. First, you have to approach your dispensary; they will provide all the information on how to apply for medical reimbursement.
From India, Hyderabad
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You cannot get reimbursement of medical expenses incurred for your father unless he was referred to private hospital by the ESI Medical Officer. Madhu.T.K
From India, Kannur
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1. Sir, I fully agree with the views expressed by Sh. Madhu T.K. above. But I feel that a period of about 4 months has elapsed, and you should have promptly contacted the concerned authorities.

2. I suggest visiting the appropriate ESI dispensary and discussing the issue with them.

From India, Noida
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Dear Sir(Madhu T.K.), But that private medical is coming under ESIC.
From India, Bangalore
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1. Sir, ESIC has its own dispensaries and hospitals, and therefore, in my opinion, will not favor referring each and every patient to other private hospitals where they have tie-up arrangements. However, ESIC has its own policies, including a referral policy for medical facilities. Accordingly, in my earlier comments, I suggested contacting the appropriate ESIC Dispensary to which you are attached.

2. I am attaching herewith a few circulars, indicating the policies of ESIC in medical benefits, including its policies relating to referring patients to tie-up hospitals. I hope the same may be helpful to you or other readers of this citeHR. These instructions/circulars are available on the website of ESIC and can be downloaded by any person interested in the matter.

3. From these circulars, I think you can find and ascertain the procedure regarding reimbursement, if allowed, in the matter you wanted to know in this thread.

From India, Noida
Attached Files (Download Requires Membership)
File Type: pdf ESIC CIRCULAR 29-08-2014 REGARDING MEDICAL SERVICES.pdf (261.7 KB, 630 views)
File Type: pdf ESIC CIRCULAR 09-11-2011 REGARDING REFRRAL OF PATIENTS.pdf (1.29 MB, 286 views)
File Type: pdf ESIC OPERATIONAL MANUAL 2014 -SUPER SPECIALITY SERVICES.pdf (923.7 KB, 659 views)

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nathrao
3251

Even for private hospitals that are tied up with ESIC, there are certain referral procedures. Other learned members have advised you correctly and Mr. Harish Kumar Mehta has attached some circulars that are useful. Read the circulars and get some information about the whole process.

However, you need to visit the ESIC office and discuss the whole matter. Further delay in meeting the officials on the ground who will handle your case of reimbursement is the most important step.

People can advise you and guide you in this learned forum, but you, as the claimant, will have to do the legwork of meeting, discussing, and finding out ways and means to get the reimbursement.

From India, Pune
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Dont confuse on this. You just contaact your Esi branch manager. They will help u clearly as. What u have to do
From India
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Sir, reimbursement of medical bills is not the subject matter of ESIC Branch Manager.
From India, Noida
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Dear Gautam,

With all your medical bills and the circumstances that led you to approach a private dispensary, as well as the conditions of your patient, please make an application and approach the Directorate of Medical-ESIC in your region to submit it. Every month, ESIC will hold a meeting to review such applications, and the committee will examine them and take necessary actions. Please ensure to ascertain the venue, time, etc., from the medical directorate and be present on the day with a copy of your application and all related documents. If possible, the patient should also accompany you. Obtain a recommendation letter from your concerned employer and, if possible, from the dispensary as well.

ESIC is a generous organization and is very accommodating in considering genuine cases and providing help. I am confident that you will succeed in this endeavor. Please act without delay. All the best.

Ram K. Navaratna
HR Resonance
Bangalore
09448274030
hrresonance@gmail.com

From India, Bangalore
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