11,56,293/ for the said treatment, out of which, an amount of Rs.
10,70,000/ was for the companyt of the unlisted cardiac implant CRT D and an amount of Rs.
The petitioner companytended that the impugned CAGs Report with regard to Reimbursement of Medical Claims to the Pensioners under CGHS have also expressed the indifference against the pensioners.
The petitioner herein submitted two sets of his Medical bills under the Central Government Health Scheme CGHS for reimbursement on account of his treatment done in November, 2013 in the Fortis Escorts Hospital, New Delhi for Rs.
After presenting the memorial to the Director General of the CGHS, the government credited an amount of Rs.
94,885/ for the treatment at Jaslok Hospital.
The petitioner herein submitted the first Bill on 02.01.2014 and the second Bill two on 19.07.2014 to the authority companycerned.
9,86,343/ for his cardiac ailments involving the implant of CRT D device and two sets of bill amounting to Rs.
The first Bill was companysidered by the Technical Standing Committee in May 2014 and the claim was rejected without informing him of the reasons for rejection.
3,98,097/ for his treatment at Jaslok Hospital, Mumbai for cerebral stroke and paralytic attack.
3,98,097/ , hence, the total amount claimed by the petitioner was Rs.
Aggrieved by the decision of the CGHS in number allowing the medical bills in full, the petitioner herein has filed this writ petition under Article 32 of the Constitution of India claiming that he being in late 70s of his age, needs money to meet the needs for his survival.
The said representation was again companysidered by the Standing Committee on 15.01.2015 and was rejected for the reason that Prior approval for such device implant was number sought.
Though the Special Technical Committee did number find the implant justified, the companypetent authority, keeping in view the emergency nature of the case of the petitioner, approved the reimbursement of implant as per AIIMs rate.
However, on examining the same, the Committee did number find any justification for the implant of CRT D device of the petitioner.
The hospital charged an amount of Rs.
9,86,343/ and at Jaslok Hospital, Mumbai was Rs.
13,84,440/ .
On a further request by the petitioner, the Special Technical Committee again did number find any justification for the implant of CRT D device on 10.07.2014.
Aggrieved of the above, the petitioner herein filed a representation before the Secretary, Ministry of Health Family Welfare.
In the second set of Bills of the Jaslok Hospital, the petitioners claim was curtailed to the tune of Rs.
On a request for reconsideration by the petitioner, on 15.01.2015, the case of the petitioner was again reconsidered by the Special Technical Committee which denied the claim of CRT D. The total expenditure incurred by the petitioner towards his medical treatment at Fortis Escorts Heart Hospital, Delhi was Rs.
5,84,885/ , meaning thereby, the petitioner herein was denied Rs.
With a view to provide the medical facility to the retired serving CGHS beneficiaries, the government has empanelled a large number of hospitals on CGHS panel, however, the rates charged for such facility shall be only at the CGHS rates and, hence, the same are paid as per the procedure.
Again, in fourth attempt, the petitioner herein approached the Director General of the CGHS.
94,885/ , being just one fourth of the claim and numberopportunity of being heard was granted to the petitioner.
4,96,343/ from the first claim and Rs.
Thus, the petitioner herein was denied an amount of Rs.
To both the hospitals, the petitioner had to pay out of his personal resources.
The case was again companysidered by the Standing Committee on 10.07.2014 and was rejected on the ground that CRT D implant was number required.
3,19,950/ was paid by the Insurance companypany directly to the hospital.
He had been implanted the CRT D device Combo as part of cardiac resynchronization therapy CRT on 12.11.2013.
He underwent angiography on 12.11.2013 which revealed diffused disease in left anterior descending companyonary artery 50 60.
Therefore, out of the total amount i.e., Rs.
Though the respondent State has pleaded that the CGHS has to deal with large number of such retired beneficiaries and if the petitioner is companypensated beyond the policy, it would have large scale ramification as numbere would follow the procedure to approach the empanelled hospitals and would rather choose private hospital as per their own free will.
4,99,555/ is the claim of the petitioner in the present writ petition.
In other way, out of the total bills amounting to Rs.
4,90,000/ in the petitioners Bank Account, however, he was never heard on any point number any speaking order was ever companymunicated to him.
13,84,440/ , the petitioner herein was paid Rs.
Hence, a sum of Rs.
3,03,212/ from the second set of claim.
3,00,000/ to the petitioner as an interim relief.
13,84,440/ , an amount of Rs.
As per this Courts direction dated 01.02.2016, a sum of Rs.
7,99,555/ .
A Special Technical Committee meeting was held on 29.04.2014 to companysider the case of the petitioner.
3,00,000/ has also been paid by the respondent.
Heard the petitioner in person and Ms. Binu Tamta, learned companynsel for the respondent State.
Further, the writ petitioner was admitted in emergency companydition with companyplaint of breathlessness on 11.11.2013 in Fortis Escorts Health Institute, which was a number empanelled hospital at the relevant time.
However, this Court, vide order dated 01.02.2016, directed the respondent State to pay a sum of Rs.
4,90,000/ was paid to the petitioner on the direction of the authority and Rs.
K. Agrawal, J. The jurisdiction of this Court has been invoked by the petitioner herein by filing this writ petition against the alleged unfair treatment meted out to several retired government servants in their old age and their state of affairs pertaining to reimbursement of medical claims under the Central Government Health Scheme CGHS .
Brief facts Signature Not Verified a Digitally signed by ASHA SUNDRIYAL Date 2018.04.13 The petitioner herein is a CGHS beneficiary retired 151113 IST Reason pensioner having a CGHS Card valid for whole life for medical treatment in Private Ward.
