Posted by: Rajib Ghosh in: CGHS
Delightfully simple, the ‘Medical 2004 Form for Reimbursement of Medical Claims of CGHS beneficieries’ is a breeze to fill-in and the submission process is extraordinarily simple. NOT.
If your near and dear is a CGHS beneficiary and received emergency in-patient treatment at a CGHS ‘non-recognised’ hospital, you are generally advised by well-wishers to buy yourself a pair of good quality sport shoes. The number of times you have to visit the offices of CGHS to seek clarification is astounding.
If your near and dear gets hit by a medical malady and requires emergency treatment, if admitting to a CGHS recognized hospital, beware that you can only admit the patient to the hospital that is recognized for that specialty. For ex: if Hospital A is recognized for nephro disorders, Hospital B for gynae disorders and Hospital C is a branch of Hospital A, for nephro emergency, you must admit the patient to Hospital A only. Admission to Hospital B & C can render your claim invalid.
In case of emergency hospitalization to a ‘CGHS non-recognized hospital’, you are generally advised to continue the treatment till the emergency subsides and you can either transfer the patient to a CGHS recognised hospital (with prior approval) or discharge the patient and bring him/her home. A ‘CGHS non-recognized’ hospital is simply a corporate hospital that charges way more than what CGHS is willing to reimburse. You may claim reimbursement and receive it on CGHS discretion only. No obligations on CGHS’s part.
Post transfer/discharge, you must obtain the ‘Medical 2004 Form for Reimbursement’ from the CGHS dispensary that your patient is attached to. Photocopies or downloaded versions from the Internet are not valid. The Medical 2004 Form requires (*=undocumented):
You will generally be provided with photocopy of the BHTs by the hospital. Be sure to get the BHTs attested by the Doctor in-charge of treatment. Also, hospitals take a lot of time to process BHT generation request and charge quite a bit for the photocopies. So, request early and visit the hospital with a load of cash on the day of collection.
* In case, you are unable to submit the reimbursement claim within the stipulated 90 days, write a letter to the Additional Director, CGHS of your city; explaining reasons for the delay obtain written permission to submit the claim within a new deadline. You must include this permission letter as an annexe in your claim-form.
When you have compiled the file with the above mentioned annexes, (*) make 2 + photocopies of the entire file. You are required to submit the original file and 1 photocopy to the CGHS Headquarters of your city and keep at-least 1 copy for your reference. CGHS will provide you a reference number on your copy. Your future communication with CGHS must include this reference number. Submission is required within 90 days from date of discharge and is accepted at the HQ only at specific dates. For ex: at CGHS HQ Kolkata; submission is accepted only on Mondays and Thursdays between 9.30a and 1.30p.
Best of luck with your claim, hope this document helped.