As per Rule 14.1 of Agreement of West Bengal Health Scheme 2008, "All bills and papers related to the beneficiaries treatment shall be handed over in original along with the necessary counter signatures by the authorised persons." As per Rule 15.1, "If any dispute or difference of any kind whatsoever (the decision whereof is not herein otherwise provided for) shall arise between the Authority of the WBHS 2008 and the Hospital/ Diagnostic Centre upon or in relation to or in connection with or arising out of the Agreement, shall be referred to for arbitration by the Director of Medical Education, West Bengal, who shall give written award of his decision to the Parties. The decision of the Director of Medical Education, West Bengal shall be final and binding. The provisions of the Arbitration and Conciliation Act, 1996 (26 of 1996) shall apply to the arbitration proceedings. The venue of the arbitration proceedings shall be at Kolkata." So just start a discussion with the Hospital authority that you are going to act as per the said rule and going to take legal action. Always keep received copy of your application as a proof. By the by, you may also contact Medical Cell at Writer’s Buildings for necessary guidance in this regard. Enter Writer’s Buildings through Gate No. 1, and then at the Ground Floor you can find ‘Medical Cell’.
He is not entitled to get the cost of follow up medicine for heart disease except cardiac surgery. Cost of one time treatment in OPD should be reimbursed. Indoor/ OPD treatment must be mentioned in Form – D by the treating Specialist. In case of Indoor treatment counter signature of Medical Superintendent is essential. Necessary declaration by the Pensioner in Form – C is sufficient. In case of Indoor treatment the pensioner claimed 11300/- as Coronary Angiography (1 day's package). As per revised rate list the new rate for the item will be 11700/-. No other charges as claimed by the pensioner is admissible. Because approved package rate is inclusive of all other charges (18 nos.) as mentioned in the Scheme. He may thus be granted Rs. 11300/- only.
9: In case of Indoor treatment at enlisted Health Care Organisations (H.C.O.) don't bother about package. Total claim will be reimbursed upon scrutiny from respective authority. If any objection arise regarding the admissibility of the disease, then, let it be clarified by the H.C.O.
11: No. You will get full on major and up to 80% on minor procedures, which depends on bed capacity of the H.C.O. It may possibly be 60% for Susrut Eye Foundation.
if prior to entry into WBHS’2008, a member was having treatment at Jaslok Hospital, Mumbai under Economy category patient, will he be allowed to continue the same treatment at the said hospital & reimbursed
