Imphal Times News Impact: ISA recommends authority to instruct JNIMS for refund
of treatment expenses of Rs 20,000/- to CMHT card holder
Source: IT News
Imphal, January 15 2020:
Responding to Imphal Times news report under the heading "Fooled by CMHT: At JNIMS , CMHT card holders patients cannot spent more than Rs.1500/- a day; Consultants sent patient to private clinic for KFT, LFT and Eco test" dated Jan 12, 2020 and follow up editorial "What ails Chief Minister gi Hakshelgi Tengbang" dated Jan 13, 2020, accompanied by a satirical Facebook post by Editor of this newspaper, Implementation Support Agency (ISA) of the Chief Minister gi Hakshelgi Tengbang (CMHT) immediately conducted an enquiry over the matter and recommended the government to instruct the Medical Superintendent of JNIMS to refund the treatment expenditure to a lady CMHT card holder Longjam Ronibala Devi of Keishamthong Longjam Leirak, Imphal West.
As per source with the Imphal Times Joyshankar & Santoshi of the Implementation Support Agency (ISA) while enquiring the matter found that the Patient Longjam Ronibala Devi, was admitted in Female Medicine Ward, JNIMS by Associate Prof Dr Th Rajendra Singh (of Medicine Department) on 24th December, 2019 .
She was advised for investigations by treating doctor on the same day ie on 24th December, 2019 from one private laboratory M/s Babina Diagnostics Centre.
Only KFT (blood test for Kidney status) was done in outside lab.
But, CMHT card was submitted to the Arogya Mitra in CMHT Help Desk only on 26th December, 2020 .
Rest of the lab tests were done in JNIMS after raising Pre-Auth under CMHT.
The ISA team was also told by the beneficiary that she had spent Rs 20,000/- from her pocket during the treatment at JNIMS from 24/12/2019 till 6/01/2020 for Medicine (Rs 8000/-) & Investigations outside the Hospital (Rs12,000/-) .
In its report to the concern government authority the Implementation Support Agency (ISA) stated that at the time of admission of Longjam Ronibala Devi, the treating doctor could have taken assistance from the Hospital MEDCO or Arogya Mitra to book the patient under CMHT from Day-1 itself.
For general ailments (before diagnosis), "General Ward" Package of Rs 1100/- per day valid for 7 days (total Rs 7700/- for 7 days) could be blocked for the treatment.
Since the patient was hospitalized for 14 days, the Package could have been enhanced / blocked for another 7 days @ Rs 1100/- per day (hence, total Rs 15,400/- for 14 days) .
ALL laboratory tests could have been done in JNIMS Lab ONLY.
Even, if the MEDCO/ Arogya Mitra felt if "appropriate" Package was not available among CMHT Package list, they could have advised the treating doctor to seek for "unspecified package" as done frequently in other such cases by other doctors in JNIMS or any other empanelled hospitals.
Currently, under CMHT/ PMJAY, there are 12 (twelve) Arogya Mitras/ MEDCOs stationed in JNIMS round the clock to assist beneficiaries/ treating doctors.
In this particular case, we may instruct MS, JNIMS to "refund" Rs 20,000/- to the beneficiary for "out of pocket expenditure" incurred during hospitalization under CMHT in JNIMS subject to production of actual bills by beneficiary for medicines/ tests purchased/done outside JNIMS.
SNC may also request the MS, JNIMS not to allow such cases to repeat in future.
SNC may reiterate the request to the beneficiaries to report their grievances to the Arogya Mitras stationed in hospitals or call TOLL FREE No 1800 103 2015 for assistance instead of going directly to the media.
Longjam Ronibala Devi, the CMHT card holder , who was denied treatment, perhaps due to ignorance has been diagnosed with RHF (rheumatic heart failure) with generalized weakness (as per Pre Auth form filled up by treating doctor Dr Th Rajendra Singh, Assoc Prof, Medicine Dept) .
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