A Central Government Health Scheme (CGHS) beneficiary Dr. Bharat Bhushan Sharma claims that he was in for a ‘rude surprise’ after he was referred to Max Super Speciality Hospital in Shalimar Bagh for an Hemorroidectomy (a surgical procedure to remove haemorrhoids), but was then told that the budget sanctioned by the CGHS did not completely cover the procedure.
“I was asked to come (empty stomach) early in the morning. There, while learning about further procedures, I was told to submit Rs. 23,000 for a haemorrhoid stapler, since (according to them) it is not included in the Rs. 43,200 budget sanctioned by the CGHS. I made a few calls and learned that the cost is included in the budget. I retaliated and showed them the copy of the MoU. But they gave me in writing that since Rs. 23,000 was not paid by me and the cost of stapler is not included in the budget, the treatment is denied.”
Dr. Sharma said that he was forced to file a complaint against the hospital in the CGHS grievance cell, office of Additional Director, Central Government Health Scheme headquarters R.K Puram.
“They took it under consideration and filed a complaint immediately. Now after six months, I got a response from the office of the Additional Director with all the detailed history and action taken in my case, in which the the authority has decided to impose a fine of Rs.1,50,000 as liquefied damages from the amount of Rs. 10,00,000 submitted by the hospital to IndusInd Bank as guarantee. The concerned bank has also requested to recoup the above amount from the hospital to maintain the amount of bank guarantee,” Dr. Sharma said.
Hospital responds
Responding to the allegations, the hospital said in a written statement: “Patient Dr. Bharat Bhushan Sharma, a CGHS beneficiary, approached Max Super Speciality Hospital, Shalimar Bagh on February 18, 2016, for a surgical procedure. The patient insisted on using a high-value stapler instead of the standard stapler for his treatment, which is not covered under the CGHS guidelines. As a standard protocol suggested by CGHS to NABH Hospitals, the patient was asked to sign a written consent for the high-value stapler, which is non-reimbursable. The patient declined to give the consent and left the hospital without admission on the same day. Max Super Speciality Hospital, Shalimar Bagh extended full support to the patient and at no point was he denied treatment or admission in the hospital. We have received the notice from CGHS headquarters on the fine amount levied and we will make our representation to the concerned authorities.”
CGHS has decided
to impose a fine
of Rs. 1.5 lakh on
the hospital as liquefied damages
