-Since two years, hospital has received no reimbursement fund from Gov
There is no wrong in saying that government have turned a blind eye to the current status of public healthcare that has been screwed up in the state. On one side government claims to provide ‘social security’ to employees falling under the Employee State Insurance Scheme (ESIS), on the another side, they have not cleared the funds for pending medical bills that have piled up to 50 lakh amount.
As many as 800 patients seeking medical reimbursement benefits from the Employee State Insurance Scheme (ESIS) have been put on long wait, as the claims have not been cleared since over last two years. The officials on the name of anonymity attribute the delay to the state government who is paying no attention to the ESIS hospitals, making the services deteriorating day after day.
Whereas State government, which should have came to the rescue of the beneficiaries, has further delayed the reimbursement without giving any specific deadline. These are the bills of patients who were referred for secondary treatment at ESIS impaneled hospitals. But nearly 800 such people, out of the total 1.5 lakh ESIS workers in Nagpur district, are running from pillar to post to get their reimbursement of 50 lakh amount. Even the ESIS hospitals lacks in every way, right from the crisis of doctors to the shortage of equipment, to provide required service to the people.
Looking at this, many more private hospitals were added in the impaneled list where the patients are referred. There are total 16 ESIS dispensaries in Nagpur district, from where 800 claims were sent for the reimbursement to the government till January this year. The claims were approved, but no money has been yet transferred for the pending bills.
It is pertinent to mark that employees who are drawing wages less than 21,000 per month, of construction workers, factories, shops, hotels, restaurants, cinemas, newspapers and other establishments are eligible for the social security benefits under the ESI scheme. Earlier, before 2017, the minimum wage was 15,000 per month. Here some amount is being exempted from salary as their part of the contribution. It may be noted that the employees have right to claim reimbursement of medical bills after getting treated at any other hospital.
The employees get free medical services at the ESIC dispensaries, impaneled clinics and hospitals for family. The beneficiaries are also eligible for secondary care in super speciality hospitals outside the ESIC facilities. It may be noted here that the bills up to Rs 25,000 are sanctioned at dispensary level. Bills ranging from Rs 25,000 to Rs 1 lakh are sanctioned at Administrative Medical Officer (AMO) while Mumbai commissioner’s office has the power to sanction bills ranging from Rs 1 lakh to Rs 3 lakh. The bills above Rs 3 lakh are sanctioned by the ministry itself.
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