I have submitted the my 8-year-old daughter's private hospital bills of Rs. 8,98,810/- on 02.02.2019. For this, they have made the reimbursement of Rs. 4,29,103/-. This amount is less than 50% of my claimed amount.
Here I will write a brief history. My daughter has been suffering from multifocal epilepsy since she was 7 years old. We have consulted various neurologists, including NIMHANS Bangalore, in the last 7 years. Finally, with the reference of our relative (who is a neurosurgeon in the same hospital), we consulted KIMS Secunderabad. They diagnosed the exact problem and suggested surgery. The surgery consists of 2 phases: the first one is Stereovideo EEG (to detect the exact location of the damaged brain part), and the second one is to remove the part. The estimation given was around 10-12 lakhs. Along with the estimation and request for permission letters, I met our local ESI hospital superintendent. They mentioned that they couldn't provide interstate treatment permission (KIMS Secunderabad), and I would have to seek treatment within the state at our tie-up hospital. However, there was no ESIC tie-up hospital with the facility for the surgery mentioned. Subsequently, our Hubli ESI hospital forwarded my request letter and surgery estimation letter to the Regional Director's office in Bangalore.
I personally took the forwarded letter and met the State Medical Officer at the RD office in Bangalore in June 2018, along with all the medical reports. They inquired about the surgery with various ESI tie-up private hospitals, but there was no facility available in Bangalore either. Initially, they did not approve the treatment due to it being interstate. Meanwhile, my daughter's condition was deteriorating, so I started following up regularly regarding permission. One day, the State Medical Officer called me and mentioned that I could proceed with the treatment, and they would try to reimburse around 75%. We underwent the 1st phase of surgery in September 2018 and the 2nd phase in January 2019, submitting the bills in February 2019.
After receiving a lesser amount, I called the State Medical Officer, who stated that they reimbursed according to government rates and that was the maximum help they could provide. I feel this is unjust since the treatment received is not available in any government hospital or ESIC tie-up hospital in my state. I have 7 years worth of medical documents, with 2-3 neurosurgeons suggesting the surgery. One neurosurgeon specifically mentioned that the patient required Stereotype surgery, a facility not available in the entire North Karnataka region. I have also consulted many hospitals in Bangalore via email regarding this surgery, and they all replied stating that no facility was available. Now, can you suggest how I can fight for this?
From India, Bengaluru
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Here I will write a brief history. My daughter has been suffering from multifocal epilepsy since she was 7 years old. We have consulted various neurologists, including NIMHANS Bangalore, in the last 7 years. Finally, with the reference of our relative (who is a neurosurgeon in the same hospital), we consulted KIMS Secunderabad. They diagnosed the exact problem and suggested surgery. The surgery consists of 2 phases: the first one is Stereovideo EEG (to detect the exact location of the damaged brain part), and the second one is to remove the part. The estimation given was around 10-12 lakhs. Along with the estimation and request for permission letters, I met our local ESI hospital superintendent. They mentioned that they couldn't provide interstate treatment permission (KIMS Secunderabad), and I would have to seek treatment within the state at our tie-up hospital. However, there was no ESIC tie-up hospital with the facility for the surgery mentioned. Subsequently, our Hubli ESI hospital forwarded my request letter and surgery estimation letter to the Regional Director's office in Bangalore.
I personally took the forwarded letter and met the State Medical Officer at the RD office in Bangalore in June 2018, along with all the medical reports. They inquired about the surgery with various ESI tie-up private hospitals, but there was no facility available in Bangalore either. Initially, they did not approve the treatment due to it being interstate. Meanwhile, my daughter's condition was deteriorating, so I started following up regularly regarding permission. One day, the State Medical Officer called me and mentioned that I could proceed with the treatment, and they would try to reimburse around 75%. We underwent the 1st phase of surgery in September 2018 and the 2nd phase in January 2019, submitting the bills in February 2019.
After receiving a lesser amount, I called the State Medical Officer, who stated that they reimbursed according to government rates and that was the maximum help they could provide. I feel this is unjust since the treatment received is not available in any government hospital or ESIC tie-up hospital in my state. I have 7 years worth of medical documents, with 2-3 neurosurgeons suggesting the surgery. One neurosurgeon specifically mentioned that the patient required Stereotype surgery, a facility not available in the entire North Karnataka region. I have also consulted many hospitals in Bangalore via email regarding this surgery, and they all replied stating that no facility was available. Now, can you suggest how I can fight for this?
From India, Bengaluru
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ESIC Form-Medical Expense Reimbursement.p df