COVID-19-infected people who are not covered under the Ayushman Bharat Pradhan Mantri Jan Aarogya Yojana-Karunya Arogya Suraksha Padhati (AB PMJAY-KASP) can get its benefits in private hospitals only if they bring a referral letter from a government hospital.
This will be implemented from Tuesday. According to Health Department sources, private hospitals empanelled under the health insurance scheme have sought clarification from the government about admitting COVID-19 infected patients who are not covered under the scheme.
Rathan Khelkar, Executive Director, State Health Agency, issued an order on September 16 saying “the claim adjudication process will be more effective with the introduction of a referral letter.” Thus, the government will bear the cost of treatment of non-AB PMJAY-KASP COVID-19-infected persons being referred from a public health facility to a private hospital only if they produce the letter. “Failure to submit this document may result in non-acceptance of the claim request,” the order says.
The referral data contain details such as the date on which the person was tested positive for the virus through a swab test. The data also mention if the test was reverse transcription-polymerase chain reaction (RT-PCR) or antigen or others, if the infected person has any co-morbidities along with COVID-19 clinical category depending on the intensity of infection, and the reason for referral.
Guidelines for treatment
The guidelines issued earlier for COVID treatment in private hospitals say people without government health insurance cover will have to pay as per the rates fixed by those institutions. The government has, however, fixed the rate of treatment for private hospitals empanelled under the AB PMJAY-KASP and institutions where patients are referred to from government hospitals. For general ward, the charge is ₹2,300 a day, intensive care unit (ICU) ₹6,500, and ICU ventilator ₹11,500. This excludes the charge for personal protection equipment kit.
