Processing of OPD Claim for Heart Diseases Category in WBHS

Government of West Bengal
Finance Department
Medical Cell, Writers’ Building

No. 84-F(MED)WB Dated- 10/05/2022

Processing of OPD claim for Heart Diseases category in WBHS

All OPD treatments for Heart Disease category vide Clause-7(1)(v) under Government Order No- 7287-F Dated 19.09.2008 are not admissible for reimbursement on the basis of only certification of treating doctor in Annexure-I, Reimbursement under this category will qualify only when a patient is diagnosised as such along with supporting clinical justification and relevant and authenticated investigation reports.

In this context, the following technical observations may be followed by the all concerned while assessing the admissibility for OPD reimbursement under Heart Diseases category as per diagnosis of a medicine specialist/ cardiologist:

Rheumatic Heart Disease will come under Heart Diseases.
If patient has a history of cardiac surgery like of Bypass Surgery, AICD, Valve Replacement or Implantation of Stent through Angioplasty or Implantation of Pacemaker, will get lifelong reimbursement of the cost of follow-up medical attendance and treatment under Cardiac Surgery category of 7(2) clause of OPD.
Investigations those help to justify a patient suffering from Heart Diseases are CT of Heart, CT Angiography, Coronary Angiography, Myocardial Biopsy, Holter Monitoring/ Analysis, Tread Mill Test (TMT), ECG and Echocardiography.
A clinical justification specifying vulnerable parameters from treating doctor may be sought for in addition to Annexure-I.

Aloke Kumar Mukherjee, WBA & AS
Joint Secretary, Finance Department
Government of West Bengal

No. 84-F dated 10.05.2022, Source

Processing of OPD Claim for Heart Diseases Category in WBHS

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