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Lata.Mishra @timesgroup.com
At least 70 surgeries at the three BMC-run hospitals, slotted under the state’s much-tomtommed medical insurance scheme that covers more than 50 lakh families earning less than Rs 1 lakh a year, have been stalled for the last four days for want of clearances.
The Rajiv Gandhi Jeevandayee Yojana, launched in 2012, was billed as a reform that would ensure the poor are not denied medical assistance due to lack of money. LastMonday, a few relatives of the patients awaiting surgeries at KEM Hospital in Parel approached Bhoiwada Police Station with complaints against the insurance scheme authorities and KEM, but were persuaded by the cops to resolve the matter with the hospital officials.
Arguments between the hospital authorities and patients’ relatives have become a daily affair, a senior KEM doctor said, adding that a few patients’ condition was “pitiable”.
One such patient is Rakesh Mungali from Vikhroli, who was admitted to KEM Hospital last week. Sixteen-year-old Rakesh needs surgery in leg after a train accident a month ago. His right leg has already been amputated, he’s also undergone a hip-replacement surgery, and his family doesn’t know how long they will be able to afford further treatment.
“Rakesh’s surgery was scheduled for last Friday, but the billing department said the clearance hasn’t been approved by the Rajiv Gandhi Jeevandayee Yojana and asked us to pay for the treatment. I have no idea what to do,” said Rakesh’s mother.
The situation is no different at the Sion Hospital and the Nair Hospital at Mumbai Central, where a total of around 22 surgeries have been stalled for the past four days.
AKEM source said that almost 15 orthopaedic surgeries under the scheme have been stalled, besides a few cardiac and neuro-surgeries. “The bills of around Rs 1crore haven’t been processed,” a source said.
The hospital dean, Dr Shubhangi Parkar, said everything was being done to ensure patients were not inconvenienced, but surgeries have been stalled because the vendors providing medical equipment under the scheme haven’t been paid.
“We have to pay the vendors around Rs 5 crore under the scheme. Obviously it’s a tedious process and our finance team is going through the documents.We have catered to 9,000 patients under the scheme, and we are working closely with the scheme authorities to find a solution,” she said.
One of the vendors Mirror spoke to said he hasn’t been paid since November 2012 (the scheme was launched in July, 2012). “My claims, amounting to Rs5 crore, are yet to be cleared. At this rate, I will have to shut shop and do something else,” he said.
Nair Hospital officials refused to comment, but Sion Hospital dean, Dr Avinash Supe, admitted there were “problems”. He said,“We recently met a senior BMC official to sort out the matter. We proposed that the process to clear vendors’ bills under the scheme should be the deans’ prerogative.”
Till the time such a compromise is arrived at, hundreds of patients will be forced to undergo prolonged hospitalisation, unless they shell out money for the treatment.
The family of Jalgaon resident Prashant Nagdev, for instance, was asked to pay Rs 15,000 at KEM Hospital to continue treatment after the claims were not processed.
Piyush Singh, CEO of the Rajiv Gandhi Jeevandayee Yojana, said he was aware of the complaints. “The claims amounting to around Rs 60 crore are yet to be processed. The problem is,we started off with eight districts in 2012 and within two years, covered the entire state.Due to increase in workload we are facing technical glitches,” he said.
Lata.Mishra @timesgroup.com TWEETS@latamishra23
A private hospital in Malad on Wednesday refused to admit several poor patients, including those battling cancer, under a government medical care scheme that guarantees free treatment to the needy.
Sanjeevani Hospital said it was forced to turn away the patients as the insurance firm appointed by the state government for the scheme had not cleared previous bills totaling Rs 1 crore. It claimed that the cash crunch had hit its supplies of crucial medicines and equipment.
Twenty of the patients who sought hospitalisation under the Rajiv Gandhi Jeevandayi Aarogya Yojana on Wednesday needed chemotherapy. One of them was 55-year-old auto driver Prithviraj Chauhan, who suffers from laryngeal cancer. He was asked to pay nearly Rs 4,000 out of his own pocket for one session.
“My husband was diagnosed with cancer six months ago, and has been unable to work since then. I now work as a maid to support the family, but I cannot arrange Rs 4,000 out of the blue,” said his wife, Sayogita.
Vidya Sonar, 40, is battling stomach cancer. She, too, was turned away from Sanjeevani.
“For the past four days, we have been making trips to the hospital for my wife’s chemo session. The hospital says it cannot admit her under the Rajiv Gandhi scheme,” said her husband, Ram Mohan, an auto driver. “I have already paid for one of her sessions, but I don’t earn enough to pay for the entire course of treatment.”
The Sonars spent most of their income to provide for their three children. Ram Mohan added: “What is the use of this scheme if hospitals refuse to help the poor?”
Nalasopara resident Parvati Shelar, 60, diagnosed with oesophageal cancer, also returned home without a chemo session. Her son, Mangesh, said that she was in a lot of pain and could barely eat anything.“With out chemotherapy, her condition will only worsen,” he said. “On March 6, Sanjeevani had admitted my mother without any questions, but now they are saying they cannot treat patients under the Rajiv Gandhi yojana.”
Mangesh was apparently told that her mother could undergo chemo at the hospital if he paid Rs7,000.“My father passed away a few years ago, and I don’t have a job right now. From where will I arrange such cash?” he said.
Sanjeevani stopped treatment poor patients under the government health programme on March 6. So far, it has refused to extend benefits promised under the scheme to at least 50 people.
Sunil Agrawal, the hospital’s medical director, said that it had no choice but to discontinue the scheme as the insurance firm concerned had not cleared previous claims.
“Because of the pending claims we cannot pay suppliers of medicines and surgical implants. The suppliers, in fact, have stopped providing the items on credit,” he said. “We sympathise with the patients, but we cannot do anything.”
Across the state, claims worth Rs 60 crore are pending. Piyush Singh, CEO of the Rajiv Gandhi scheme, acknowledged that some hospitals were facing issues. “We had a meeting with National Insurance Company Ltd and they assured us of settling all the claims by March 31,” he said.
On private hospitals like Sanjeevani turning away patients, Singh said: “These hospitals have signed a memorandum of agreement with us and they cannot deny treatment to a single patient. I will look into the complaints.”
KEM, Sion cancel surgeries, angered patients call cops
As hospitals delay release of funds, vendors stop supplies, hitting surgeries under Rajiv Gandhi Jeevandayee Yojana KEM alone called off at least 50 surgeries in the past week, Sion, Nair hospitals cancel around 20
Lata.Mishra @timesgroup.com
TWEETS @_MumbaiMirror
At least 70 surgeries at the three BMC-run hospitals, slotted under the state’s much-tomtommed medical insurance scheme that covers more than 50 lakh families earning less than Rs 1 lakh a year, have been stalled for the last four days for want of clearances.
The Rajiv Gandhi Jeevandayee Yojana, launched in 2012, was billed as a reform that would ensure the poor are not denied medical assistance due to lack of money. LastMonday, a few relatives of the patients awaiting surgeries at KEM Hospital in Parel approached Bhoiwada Police Station with complaints against the insurance scheme authorities and KEM, but were persuaded by the cops to resolve the matter with the hospital officials.
Arguments between the hospital authorities and patients’ relatives have become a daily affair, a senior KEM doctor said, adding that a few patients’ condition was “pitiable”.
One such patient is Rakesh Mungali from Vikhroli, who was admitted to KEM Hospital last week. Sixteen-year-old Rakesh needs surgery in leg after a train accident a month ago. His right leg has already been amputated, he’s also undergone a hip-replacement surgery, and his family doesn’t know how long they will be able to afford further treatment.
“Rakesh’s surgery was scheduled for last Friday, but the billing department said the clearance hasn’t been approved by the Rajiv Gandhi Jeevandayee Yojana and asked us to pay for the treatment. I have no idea what to do,” said Rakesh’s mother.
The situation is no different at the Sion Hospital and the Nair Hospital at Mumbai Central, where a total of around 22 surgeries have been stalled for the past four days.
AKEM source said that almost 15 orthopaedic surgeries under the scheme have been stalled, besides a few cardiac and neuro-surgeries. “The bills of around Rs 1crore haven’t been processed,” a source said.
The hospital dean, Dr Shubhangi Parkar, said everything was being done to ensure patients were not inconvenienced, but surgeries have been stalled because the vendors providing medical equipment under the scheme haven’t been paid.
“We have to pay the vendors around Rs 5 crore under the scheme. Obviously it’s a tedious process and our finance team is going through the documents.We have catered to 9,000 patients under the scheme, and we are working closely with the scheme authorities to find a solution,” she said.
One of the vendors Mirror spoke to said he hasn’t been paid since November 2012 (the scheme was launched in July, 2012). “My claims, amounting to Rs5 crore, are yet to be cleared. At this rate, I will have to shut shop and do something else,” he said.
Nair Hospital officials refused to comment, but Sion Hospital dean, Dr Avinash Supe, admitted there were “problems”. He said,“We recently met a senior BMC official to sort out the matter. We proposed that the process to clear vendors’ bills under the scheme should be the deans’ prerogative.”
Till the time such a compromise is arrived at, hundreds of patients will be forced to undergo prolonged hospitalisation, unless they shell out money for the treatment.
The family of Jalgaon resident Prashant Nagdev, for instance, was asked to pay Rs 15,000 at KEM Hospital to continue treatment after the claims were not processed.
Piyush Singh, CEO of the Rajiv Gandhi Jeevandayee Yojana, said he was aware of the complaints. “The claims amounting to around Rs 60 crore are yet to be processed. The problem is,we started off with eight districts in 2012 and within two years, covered the entire state.Due to increase in workload we are facing technical glitches,” he said.
PRASHANT NAGDEO, 24| SURGERY: Shoulder dislocation SURGERY WAS SCHEDULED FOR: Wednesday
After doctors called off the operation as the implants under the government scheme were not available, the family borrowed Rs 15,000 to get the surgery done
After doctors called off the operation as the implants under the government scheme were not available, the family borrowed Rs 15,000 to get the surgery done
========
Malad hospital turns away RGJAY patients
In the past week, Sanjeevani Hospital in Malad has denied admission to 50 patients, many of whom are battling cancer
Lata.Mishra @timesgroup.com TWEETS@latamishra23
A private hospital in Malad on Wednesday refused to admit several poor patients, including those battling cancer, under a government medical care scheme that guarantees free treatment to the needy.
Sanjeevani Hospital said it was forced to turn away the patients as the insurance firm appointed by the state government for the scheme had not cleared previous bills totaling Rs 1 crore. It claimed that the cash crunch had hit its supplies of crucial medicines and equipment.
Twenty of the patients who sought hospitalisation under the Rajiv Gandhi Jeevandayi Aarogya Yojana on Wednesday needed chemotherapy. One of them was 55-year-old auto driver Prithviraj Chauhan, who suffers from laryngeal cancer. He was asked to pay nearly Rs 4,000 out of his own pocket for one session.
“My husband was diagnosed with cancer six months ago, and has been unable to work since then. I now work as a maid to support the family, but I cannot arrange Rs 4,000 out of the blue,” said his wife, Sayogita.
Vidya Sonar, 40, is battling stomach cancer. She, too, was turned away from Sanjeevani.
“For the past four days, we have been making trips to the hospital for my wife’s chemo session. The hospital says it cannot admit her under the Rajiv Gandhi scheme,” said her husband, Ram Mohan, an auto driver. “I have already paid for one of her sessions, but I don’t earn enough to pay for the entire course of treatment.”
The Sonars spent most of their income to provide for their three children. Ram Mohan added: “What is the use of this scheme if hospitals refuse to help the poor?”
Nalasopara resident Parvati Shelar, 60, diagnosed with oesophageal cancer, also returned home without a chemo session. Her son, Mangesh, said that she was in a lot of pain and could barely eat anything.“With out chemotherapy, her condition will only worsen,” he said. “On March 6, Sanjeevani had admitted my mother without any questions, but now they are saying they cannot treat patients under the Rajiv Gandhi yojana.”
Mangesh was apparently told that her mother could undergo chemo at the hospital if he paid Rs7,000.“My father passed away a few years ago, and I don’t have a job right now. From where will I arrange such cash?” he said.
Sanjeevani stopped treatment poor patients under the government health programme on March 6. So far, it has refused to extend benefits promised under the scheme to at least 50 people.
Sunil Agrawal, the hospital’s medical director, said that it had no choice but to discontinue the scheme as the insurance firm concerned had not cleared previous claims.
“Because of the pending claims we cannot pay suppliers of medicines and surgical implants. The suppliers, in fact, have stopped providing the items on credit,” he said. “We sympathise with the patients, but we cannot do anything.”
Across the state, claims worth Rs 60 crore are pending. Piyush Singh, CEO of the Rajiv Gandhi scheme, acknowledged that some hospitals were facing issues. “We had a meeting with National Insurance Company Ltd and they assured us of settling all the claims by March 31,” he said.
On private hospitals like Sanjeevani turning away patients, Singh said: “These hospitals have signed a memorandum of agreement with us and they cannot deny treatment to a single patient. I will look into the complaints.”
(Left) Prithviraj Chauhan (l) with his wife Sayogita; (Right) Vidya Sonar (r) and her husband Ram Mohan at Sanjeevani Hospital
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