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CGHS – Delay in clearing bills hurts beneficiaries

All is not well with the Central Government Health Scheme (CGHS) in Bangalore. Considered to be a silver lining for pensioners, government servants and freedom fighters, CGHS has now become a painful experience for the beneficiaries here.

The problems are plenty when it comes to reimbursement of medical bills. One of the main reasons given to the beneficiaries for not reimbursing on time is shortage of funds.

MN Sheikh (name changed), 67, a pensioner, has been visiting the ‘E’ wing of Kendriya Sadan in Koramangala, which houses the office of the additional director of CGHS, Bangalore, for over seven months now.

“I submitted my medical claim bill with the medical reimbursement claim (MRC) section about seven months back. Three of my bills have been pending for clearance since then. My wife and I depend on my pension. She is a cancer patient and such delay in clearing bills is affecting my financial stability,” said Sheikh, a resident of Vijayanagar.

Another pensioner, on condition of anonymity, said that many hospitals and diagnostic centres empanelled with the central government are refusing to admit the patients under CGHS. “They either say that they don’t have bed or simply refuse to admit us because they are not reimbursed by the government in time. Nobody wants to run into loss these days,” said the pensioner.

Said a doctor with MRC, CGHS, Bangalore: “The situation has become much more comfortable in the past few months. We are clearing files (of claims) within three months now. There were delays on certain occasions because we were short-staffed, but now the recruitments have started and situation has improved. Sometimes the files are delayed because the beneficiaries do not submit proper documents and bills.”

Hospitals empanelled with the CGHS in Bangalore too face difficulties when it comes to reimbursing medical bills. Said KS Vasuki, general manager, corporate relations, Narayana Hrudayalaya: “Reimbursement bills are not cleared by the department in time. Sometimes the bills are cleared within one or two weeks and sometimes it takes more than six months. Also many queries are asked by the third party agency, which reimburses the bills on behalf of the government. The entire procedure becomes too tedious to follow.”

Objective of CGHS

To provide comprehensive medical care facilities to central government employees and members of their family.

To do away with the cumbersome and expensive system of reimbursement of medical expenses.

Source:  Times of India