Jaipur: Private hospitals and nursing homes society (PHNHS) president Dr. Vijay Kapoor claimed on Thursday that claims filed under the state govt’s Chiranjeevi health insurance scheme (now renamed as Mukhyamantri Ayushman Swasthya Bima Yojana) were being rejected on filmy grounds.
“One claim has been rejected just because the patient took treatment from a hospital that was 60 km away from his residence,” Dr Kapoor said.
“Private hospitals are applying for claims for the admitted patients, but even after the discharge of the patients, the claims are rejected for illogical and ridiculous reasons. Around 20% to 25% claims are getting rejected, which is a cause of concern for us,” he said.
He pointed out that the rejection of claims would cause losses to private hospitals, which in turn would affect patient services. “Claims are rejected if a surgeon from Jaipur performs a surgery in a hospital in some other district. “It was not so in the MoU signed,” Dr Kapoor said. PHNHS has appealed to the government to resolve such issues for the benefit of patients. “We demand that the government take the private sector and PHNHS into confidence,” said Dr Kapoor.
“One claim has been rejected just because the patient took treatment from a hospital that was 60 km away from his residence,” Dr Kapoor said.
“Private hospitals are applying for claims for the admitted patients, but even after the discharge of the patients, the claims are rejected for illogical and ridiculous reasons. Around 20% to 25% claims are getting rejected, which is a cause of concern for us,” he said.
He pointed out that the rejection of claims would cause losses to private hospitals, which in turn would affect patient services. “Claims are rejected if a surgeon from Jaipur performs a surgery in a hospital in some other district. “It was not so in the MoU signed,” Dr Kapoor said. PHNHS has appealed to the government to resolve such issues for the benefit of patients. “We demand that the government take the private sector and PHNHS into confidence,” said Dr Kapoor.
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