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December 27, 2012 at 7:11 pm #68334
I have observed that, while scrutiny and sanctioning of the reimbursement claims by the authority, the expenditure incurred by the incumbent on Consumables and Disposables are also getting sanctioned, though the incumbent has undergone package treatment. I suppose the Cost incurred on Package treatment also includes cost on consumables and disposables. It should not be charged by the hospital nor should be sanctioned. Am I right? Moreover the cost incurred by the incumbent on purchase of medicine after discharge from hospital, is not being sanctioned or is cut. But I suppose cost for medicine purchase for 3 months is admissible if advised by the doctor in prescription/discharge advice as the continuing required medicine. Am I correct? Any body ready with correct clarification?December 28, 2012 at 3:25 am #76189
Related Orders are attached. Please have a look. All orders related to Health Scheme is available in Finance Department’s website http://www.wbfin.nic.in/Page/publication.aspx?type=09. under ‘Circulars & Memos’, ‘West Bengal Health Scheme’.December 28, 2012 at 4:29 pm #76195
Orders are there. Actually I wanted the correct interpretation. I wanted to know whether my interpretation was correct or not? I wanted to know whether the cited example of sanction, done by some authority was incorrect or not. Would be happy to receive feed backs and opinions. However thanks for the response.December 29, 2012 at 11:47 am #76204
Cost of disposables and consumables
That depends actually whether the medical case, for which the package rate has been claimed, is a surgical one or not.
As per rule, ‘Package rate’ means and includes lump sum cost of in-patient treatment/day care/diagnostic procedures, etc. (Para 5 of G. O. No: 3474 F dt. : 11.05.09). Package rate includes cost of surgical disposables and all sundries used during hospitalization (point xiv of (5) of W.B.H.S., 2008) and disposables like bandages, anaesthetic drugs, syringes, etc. ( as illustrated for TRUP, the procedures such as Urethral Catheterization, Cystoscopy, etc.) should not be billed separately as they are all part of the Procedure (Para of Annexure B)
But for non-surgical cases, reimbursable amount may be calculated adding charges for doctor’s visit, bed, investigations, medicines, consumables etc. as per approved rates. (Para 3 of G.O. No. No. 797-F (MED) dt. 31-01-2011).
If any Government employee/ pensioner or beneficiary is admitted in a recognized hospital on emergency basis, cost of medical attendance and treatment before the ‘Package period’ may be reimbursed adding bed rent , investigation charges, cost of medicines, doctor’s visit, consumables etc.
For medical treatment in non-empanelled private hospital/ nursing home, Cost of admissible medicines and consumables will be reimbursed up to 80% or 60% of the actual costs, as the case may be. (Q. No. 2 of G. O. No. 11254-F (MED) Dt. 16-12-2011).
For surgical cases/ packages, where there are no WBHS 2008 prescribed rates, charges for services shall be arrived at by calculating admissible amount item-wise (e.g. room rent, investigations, cost of medicines, procedure charges based on similar types of cases etc) as per approved rates/ actual expenditure. (Para 2.3 of Annexure – C).
Cost of Medicine
Cost of medical attendance and treatment includes the cost of medicines purchased from outside on the advice of the attending physician at the hospital or institution but as an indoor patient in a hospital or an institution. (Rule 6 of W.B.H.S., 2008). The time frame of 3 months, as you mentioned, I missed the specific directive of the Govt. in this regard.
An employee or his beneficiary is however entitled to reimbursement of the cost of follow-up medical attendance and treatment relating to Neuro Surgery, Cardiac Surgery (Including Coronary Angioplasty and implants), Cancer Surgery/Chemotherapy/Radiotherapy, Renal Transplant, Hip/Knee replacement Surgery and Accident cases received as an OPD patient in a hospital or institution. (Rule 7(2) of W.B.H.S., 2008)
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