Apex consumer panel says onus of selecting the right hospital lies with the beneficiary

Yeshaswini Cooperative Health Care Scheme is meant for farmers, who are members of Cooperative Societies. By paying Rs. 210 a year, a farmer in Karnataka can get treatment and undergo medical procedures in 440 hospitals including 20 from the district. A member can avail free surgery costing up to Rs.1 lakh for a single surgery and Rs.2 lakh for multiple surgeries in one year. As many as 805 types of surgeries are covered.

Beneficiaries of Yeshaswini Cooperative Farmers Health Care Scheme must get treatment in hospitals empanelled ( under the scheme) if they want to ensure that their claims are not rejected.

The responsibility of selecting the right hospital lies with the beneficiary even if he/she is an illiterate, according to a recent order of the National Consumer Disputes Redressal Commission.

The Commission made this observation while hearing a batch of revision petitions filed against the order of Dakshina Kannada District Consumer Disputes Redressal Forum.

The Commission observed beneficiaries would choose (other hospital) “at his own peril.”

Revision petitions were filed by the chief executive officer of the scheme in Karnataka against the orders of the Consumer Forum directing the officer to reimburse to beneficiaries the expenses of treatment availed in Dhanvantari Hospital in Puttur. The chief executive officer refused to reimburse treatment expenses on the ground that the hospital was not among the approved hospitals under the scheme. In the judgement, Justice J.M. Malik pointed to the condition No. 14, which states that beneficiaries of the scheme could avail facilities in the registered hospitals of rural areas or in the network hospitals and nursing homes in the State.

The Judge turned down the argument of beneficiaries that they were entitled for reimbursement as the card issued to them did not have a list of network hospitals. Dhanvantari Hospital was not among the listed hospitals, the Judge noted in his order dated May 14.

‘Fair play’

“All the claims must be strictly determined by the canons of fair play and justice.

“The issue cannot be ducked in the way the complainants want. This fact cannot obscure the fundamental fact that the patient is bound to select one of the approved hospitals,” the Judge said.

The National Commission allowed the 11 revision petitions and dismissed orders passed by the State Consumer Commission and the District Consumer Forum.

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