Question : CGHS BENEFICIARIES REFERRED FOR PRIVATE CLINICAL TEST

(a) whether CGHS beneficiaries admitted in Dr. Ram Manohar Lohia Hospital for treatment are referred to a particular private laboratory for the clinical test of blood, urine and other clinical tests being this facility is not available in this hospital;

(b) if so, the details of such laboratories which have been recognized by the CGHS;

(c) whether the bills of such patients who get the clinical test in private laboratories are not verified/counter-signed by the hospital authorities;

(d) if so, the reasons therefore; and

(e) the details of existing policy or directions for the reimbursement to the beneficiaries of CGHS in this regard?

THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (PROF. RITA VERMA)

(a) No, Sir.

(b) In view of (a) above, the question does not arise.

(c) It is not correct that the bills are not verified by the treating doctors/Head of Unit/Head of Department of the Hospital.

(d) In view of (c) above, the question does not arise.

(e) When a CGHS beneficiary takes treatment/diagnostic test in a Govt. Hospital, the reimbursement is made as per actuals. In case, the treatment/diagnostic test is taken in a private hospital/private hospital recognised under CGHS, the reimbursement of medical expenses is made as per Govt. approved rates. However, if no approved rates for a particular test, etc. is available, then the reimbursement is allowed as per AIIMS rate or actuals, whichever is less. If the AIIMS rate is also not available, then the reimbursement is made as per actuals.