ry

.

Dr. N. Ravindra Shetty Orthopaedic Surgeon,

discussing Anyuta - Pilot Project – Karnataka, with Honorable President of India Abdul J. Kalam, at Bangalore on 20th August 2005,

Great Indian Dream

SIPF Mediclaim of Rajasthan –Premium less than Rs.600 per family

Bhamashah Swashthya Bima Yojana of Rajasthan 2015 -16 started with a

Premium of only Rs 370 per family now Rs,1,263 per family per year

National Health Protection Scheme (NHPS) of Budget 2018 Premium

recommended is Rs.1200 per family for Rs.5 lakhs cover

Health Care for all Insurance driven health care

Family Group Health Insurance. Six members Rs.5 lakhs cover at a

Premium of Rs.1500 per family per year on floater

Put the money back into people pocket by sharing the Insurance

Premium at 40:30:30 Center : State : family

COST DIFFERENCE

Name of the

PatientIllness Hospital Bill Specialty Super Specialty Difference

Apollo

BGS

Narayana

Jayadeva

Kidwai

Nephro Urology

Medical College hospitals

Please check every file for all the criteria written here under

Check List for Policyholder

Policy Details Hospital Details. Main Bill.

1. Policy Cop

(Sum Insured / validity)

1. Name the Primary Doctor.

(Mobile/ Landline Number/ E – mail / Website)

1. Break up of Final Bill.

2. Claim Form.

(Signed by Policyholder)

2. Name the Specialists.

(Mobile & Landline Number)

2. Receipts of all bills.

(Signed by the Doctor / Patient)

3.Copy of the ID Card. 3. Investigations ordered and the Reports - Signed by Specialists in the Specialty.

(Name, Qualification, Registration number)

3. Advance paid receipt.

4. Name of the Insurance Co. 4. Doctor’s Prescription / dispensed Medicine Bill

(Signed by the qualified Pharmacist (Name, Qualification, Registration number)

4. Anyuta – Payment details.

5. Zone/Division/Branch 5. Discharge Summary in Anyuta Format

(Diagnosis, ICD Code, Treatment given, Follow up instructions)

5. Covering letter.

6. Contact number. 6. Contact number. 6. Contact number.

7. E- Mail address. 7. E- Mail address. 7. E- Mail address.

8. Policy Limit 8. Pre – authorization request - Copy 8. Discount Offered

9. Anyuta TPA Authorization Letter for Cashless facility - Copy

ANYUTA - TPA ABY Claim Settlement Format :

CCNPLEASE MENTION

REIMBURSEMENT/CASHLESS PLEASE MENTION PREVIOUS CLAIM DETAILS ( IF ANY)

Total Sum insured REIMBURSEMENT

Available Balance HOSPITAL NAME CLAIMED DOA DOD 0

Room Stay 0

ICU Stay0 0 0 0

CLAIMED AMOUNT RS./-, BILLS / MEMOS ATTACHED

RS.0/-, PAID BY PARTY RS.REIMBURSEMENT/-.

CODE DATE BILL NO SERVICES CLAIM DISCOUNT DEDUCTION PAYABLE DOCTOR'S REMARK

Name

Age / Sex

Employment No.

Aadahaar Card Number

Contact No

Summary

Diagnosis

Treatment given

Procedure done

Cost incurred

Doctors Fee

Medicine

Surgical Sundries

Medical sundries

CGHS Medicine Code

CGHS Investigation Code

CGHS Blood Test Code

Implants

Total Cost

Package CGHS Code

Package Rate

Signature of the Hospital

authority

NOTE: CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU and room. Request the Hospital to apply CGHS rates for Consultation/ Investigation / Procedure/ Medicine/ ICU / room and send the bill for

Claim processing and settlement. Request the Hospitals to send the Doctor`s Ethical Certificate to justify, admission, invest igation, medication, procedure and the Costs. Anyuta Format is enclosed here with for you to send it to all

empaneled hospitals. With this method there will not be any delay in claim processing and settlement. This will also save revenue for the ABY Scheme.

Sl. No Name Procedure done Claimed AmountSettled

AmountHospital Remarks

1 Ashok B Wajre

Elective Coronary Artery Bypass

Grafting X LIMA - OM, RSGV-

LAD/PDA/ PLV

Narayana

Hrudayalaya

The Bill states the Procedure is SPONSORED

Please find out from the Hospital who was the

SPONSORER and has he paid in full.

CGHS has separate rates for Consultation/ Investigation

/ Procedure/ Medicine/ ICU and room.

Request the Hospital to apply CGHS rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU

and room and send a fresh bill for Claim processing and

settlement.

2 Revanna H NConservative Line Of

TreatmentMangala Hospital

Can be settled

CGHS has separate rates for Consultation/ Investigation

/ Procedure/ Medicine/ ICU and room.

Request the Hospital to apply CGHS rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU

and room and send a fresh bill for Claim processing and

settlement.

20 Shiv Shankar Gowda CS Dialysis Appolo

This for chronic renal failure for Haemodialysis.

Chronic disease needs repeated admission and treatment and sometimes life long,

like kidney failure / Cancer/ Heart disease / Neurological disorder

Haemodialysis @ Basic Cost + 20%

Our advice is negotiate with the hospital for a package rate as mentioned above

21 Tanuja Kolkar Dialysis

Shakunthala Memorial

Hospital & research

Centre

Haemodialysis @ Basic Cost + 20%

Cancer @ @ Basic Cost + 20%

Our advice is negotiate with the hospital for a package rate as advised above

22 DakshayaniMedical

managementBGS Global Hospital

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for Consultation/

Investigation / Procedure/ Medicine/ ICU and room and settle the Claim

23 Ganesh Krupa V MRI-Spine Suguna Hospital

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for Consultation/

Investigation / Procedure/ Medicine/ ICU and room and settle the Claim

24 Gopal KrishnaDJ Stent Removal

Under LASuguna Hospital

DJ Stent Removal Under LA. Could have been done as an outpatient procedure?

We need doctor’s ethical certificate to process

This file ethical certificate enclosed email.

None can interfere with the Treatment. But doctor should justify his Patient

Management ( admission and treatment line and costs)

25 GowrishreeConservative Line

Of TreatmentSuguna Hospital

Could this have been treated as Outpatient?

We want doctor`s ethical certificate for justify investigation of the cost to process and

settle the claims.

None can interfere with the Treatment. But doctor should justify his Patient

Management ( admission and treatment line and costs)

26 Gururaja Raos NConservative Line

Of TreatmentApollo BGS Hospital

None can interfere with the Treatment. But doctor should justify his Patient

Management ( admission and treatment line and costs)

27 JayalakshmiMedical

ManagementG S M

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU and room and

settle the Claim

28 JayammaApollo BGS

Hospital

Patient was admitted for 5 days and expired.

The total bill amount is 1,43,380/-

We advise to request the hospital to reduce the cost.

29 Padmaja K 1 ESWL LithotripsyHitech Kidney

stone Hospital

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU and room and

settle the Claim

30 Padmaja K 2 Flush Therapy Suguna Hospital

Discharge against medical advice

We need an Ethical certificate signed by the primary physician who

admitted patient stating the admission was needed and the cost is

Genuine.

None can interfere with the Treatment. But doctor should justify his

Patient Management ( admission and treatment line and costs)

31 RanganathMedical

ManagementSuguna Hospital

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU and room and

settle the Claim

32 Shankar M RBilateral stenting

Under SASuguna Hospital

Patient is admitted for Right Ureteric Calculi

We want doctor`s ethical certificate for justify investigation of the cost to

process and settle the claims.

None can interfere with the Treatment. But doctor should justify his

Patient Management ( admission and treatment line and costs)

33 Sundar M R

Medical

Management Suguna Hospital

Can be settled

Request the Hospital to send a bill applying CGHS Code and rates for

Consultation/ Investigation / Procedure/ Medicine/ ICU and room and

settle the Claim

34Venkata

Krishnaiah

Medical

ManagementBGS Global

Hospital

Patient admitted on 18/10/12 discharge 19/10/12 against medical

advice.

We need doctor`s ethical certificate for justify investigation of the cost to

process and clear the bill.

None can interfere with the Treatment. But doctor should justify his

Patient Management ( admission and treatment line and costs)

NOTE : These patients are treated for Malignancy / Chronic disease requiring prolonged treatment.

Chronic disease needs repeated admission and treatment and sometimes life long, like kidney failure / Cancer/ Heart disease / Neurological disorder.

CGHS has separate rates for Consultation/ Investigation / Procedure/ Medicine/ ICU / Chemo & Radiotherapy and room.

Request the Hospital to send a bill applying CGHS Code and rates for Consultation/ Investigation / Procedure/ Medicine/ ICU /Chemo & Radiotherapy/ room , etc, then settle the Claim using

the formulae given below after negotiation with the Hospitals. Radiotherapy / Chemotherapy @ Basic Cost + 20%

Our advice is negotiate with the hospital for a package rate as mentioned above

Sl. No Name Procedure doneClaimed

Amount

Settled

AmountHospital Remarks

1Dakshina

Murthy

Intensity

Modulated

Radiation

Therapy

1,10,770 0Bangalore Institute of

Oncology

This patient is for chemotherapy

We need the details of the disease , Line of treatment , cost involved to process and settle this claim

We need Doctors ethical certificate

2Dakshina

Murthy

Brainsten

Glioma For

Supportive Care

3,00,326 0Bangalore Institute of

Oncology

This patient is for chemotherapy

We need the details of the disease , Line of treatment , cost involved to process and settle this claim

We need Doctors ethical certificate

3 A Sagai

Upper GI

Endoscopy With

Biopsy

1,13,400 0Bangalore Institute of

Oncology

We need the details of the disease , Line of treatment , cost involved to process and settle this claim

We need Doctors ethical certificate

4 Nagalakshmi 21,200 0Bangalore Institute of

OncologyThis patient is for chemotherapy

5 Nagalakshmi 35,310 0Bangalore Institute of

OncologyWe need the details of the disease , Line of treatment , cost involved to process and settle this claim

6 Nagalakshmi 17,185 0Bangalore Institute of

OncologyWe need Doctors ethical certificate

7 Nagalakshmi 31,208 0Bangalore Institute of

OncologyThis patient is for chemotherapy

8 Nagalakshmi 5,805 0Bangalore Institute of

OncologyWe need the details of the disease , Line of treatment , cost involved to process and settle this claim

9 Nagalakshmi 35,813 0Bangalore Institute of

OncologyWe need Doctors ethical certificate

10 Nagalakshmi 22,975 0Bangalore Institute of

OncologyThis patient is for chemotherapy

11 Nagalakshmi 33,214 0Bangalore Institute of

OncologyWe need the details of the disease , Line of treatment , cost involved to process and settle this claim

12 Nagalakshmi 25,624 0Bangalore Institute of

OncologyWe need Doctors ethical certificate

13 Nagalakshmi 14,822 0Bangalore Institute of

OncologyThis patient is for chemotherapy