reimburse cost of surgery to retd employee: HC to centre
MUMBAI, June 7 -- The Bombay high court on Friday directed the central government to fully reimburse the medical expense of a pensioner who underwent heart transplant in a private hospital in 2019 as hospitals empanelled under Central Government Health Scheme (CGHS) could not provide him the required treatment. The court has granted four weeks to the central government to reimburse the full expenses.
CGHS empanelled hospitals provide healthcare services to central government employees, pensioners and their dependents at affordable rates.
The pensioner, Anirudh Prataprai Nansi, was diagnosed with Cardiomyopathy in 2009. The condition aggravated in 2019 and doctors advised him immediate heart transplant. As CGHS-empanelled hospitals did not have the license, and expertise, he sought treatment at the privately owned Sir H. N. Reliance Foundation Hospital. Prior to the surgery, he notified CGHS authorities regarding the cost.
After multiple follow ups, CGHS authorities responded to Nansi's reimbursement request in March 2021, stating that they could provide only Rs.69,000 out of the total expense of Rs.22 lakh, as per CGHS's Mumbai rate list.
Nansi approached the high court in 2021. The court appointed committee heard the case and opined that the full expense could not be reimbursed as it did not match CGHS rates. The committee noted that since the heart transplantation was planned and not an emergency, the reimbursement should be as per CGHS rules.
Nansi again approached the high court in 2022, citing violation of his fundamental right to life and pleading that the full expense be reimbursed to him as government hospitals lacked the facilities. On Friday, the division bench of justices G S Kulkarni and Advait Sethna observed that Nansi cannot be deprived of full reimbursement when he had to undergo treatment at a private hospital as the surgery had to be done immediately. The central government is obliged to grant reimbursement on a case to case basis, the court said....
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