Hundreds of claims get rejected on whimsical grounds. Most of the rejected cases are of cancer patients.
Nagpur News: The much talked and publicized Rajiv Gandhi Jivandayi Health Scheme launched by Maharashtra Government for the benefit of poor patients is turning out to be a mirage. The objective of the Scheme is to improve access of Below Poverty Line (BPL) and Above Poverty Line (APL) families to quality medical care for identified speciality services requiring hospitalization for surgeries and therapies or consultations through an identified network of health care providers
However, the Scheme is posing more problems to the poor patients than a remedy. In fact, the patients are undergoing umpteen difficulties and are deprived of benefits, instead. The concerned insurance company is rejecting claims of patients on whimsical grounds. If the information gathered is to be believed, around 250 cases have been rejected in Government Medical College and Hospital. Moreover, more than 85 percent claims of cancer patients are rejected till now.
Since the scheme started, around 3400 patients applied for the benefit. Out of which 1373 patients were given the Scheme benefit and amount from the insurance company was returned to them after the treatment. 92 patients are awaiting approval from the insurance company. A total 1479 cases have been sanctioned by the insurance company from the total number of applied cases. But a large number of cases are still waiting to be approved. Moreover, the insurance company has rejected more than 244 patients’ claims for one reason or the other. But again, all these figures are subject to scrutiny. The figure could be manifold.
The insurance company has been assigning reasons like the medical treatment being given to some patients is not notified in the list of the insurance company and hence depriving the patients the advantage of the Scheme.
The situation in the Super Specialty Hospital of GMCH is no different. So far 983 patients have applied for getting the benefit under the health scheme. 18 claims were rejected. Very few patients’ claim amounts have been credited to their accounts by the insurance company with drastic cut in actual treatment bill. However, most of the cases are still awaiting the approval.
The insurance company has sanctioned Rs 1.65 crore for patients from GMCH and Rs 4.22 crore have been deposited in the super specialty account. Claims of patients amounting to Rs 8.65 lakh in GMCH and Rs 11 lakh in Super Specialty Hospital are still waiting to be approved. The insurance company has rejected several claims by giving frivolous reasons and is giving more jitters to the poor patients than the relief. Majority of rejected claims are that of cancer patients.