20% Cut Medical Reimbursement Private Non-Referral Hospital Treatment GO 175

20% Cut Medical Reimbursement Private Non-Referral Hospital Treatment GO 175. MEDICAL ATTENDANCE – Medical Treatment of Government/Retired Employees and their dependents – Reimbursement of Expenditure – Treatment in Private recognised Hospitals within and outside the State– Admissibility of Medical Expenditure with 20% cut on eligible amount without referral from Nizam's Institute of Medical Sciences, Hyderabad/Sri Venkateswara Institute of Medical Sciences, Tirupati in cases of emergencies – Orders – Issued. HEALTH MEDICAL & FAMILY WELFARE (K1)DEPARTMENT G.O.Ms.No. 175 Dated :29.05.1997 

20% Cut Medical Reimbursement Private Non-Referral Hospital Treatment GO 175

Read the following:
  • G.O.Ms.No. 38, HM&FM (K1) Dept., dt. 23.1.1996
  • G.O.Ms.No.258, HM & FW, dated : 15.6.1996
  • From the President, APNGOs Association, Representationdated : 22.3.1996 and representation from certain service Associations.
  • From the Director of Medical Education,Lr.Rc.No.3773/MA.A/96, dated : 9.10.1996.
O R D E R:
  1. In the Government Orders 1st and 2nd read above, orders were issued permitting the State Government Employees, both serving and retired to secure treatment in Private Hospitals within and outside the State indicated therein that under Rule 7 of the Andhra Pradesh Integrated Medical Attendance Rules, 1972,on a reference made by Nizam's Institute of Medical Sciences/Sri Venkateswara Institute of Medical Sciences.
  2. 2. In the reference 3rd read above, the Andhra Pradesh Non-Gazetted Officers Association and some other service Associations represented that the orders issued in the Government Orders 1st and 2nd read above are not beneficial to the employees because of the condition that the employee has to obtain a referral certificate from Nizam's Institute of Medical Sciences, Hyderabad/SriVenkateswara Institute of Medical Sciences, Tirupati to get treatment in Super Speciality Hospitals within or outside the State and requested that this stipulation be omitted.
  3. 3. It has been observed that a number of cases are being referred to Government for relaxation of the Andhra Pradesh Integrated Medical Attendance Rules, 1972 when the treatment has been obtained directly at the Private Hospitals without referral from Nizam's Institute of Medical Sciences, Hyderabad /Sri Venkateswara Institute of Medical Sciences, Tirupati in view of the serious nature of the patient and lack of sufficient time to obtain such referral letter from the hospitals stated above.
  4. 4. After careful consideration of this issue in consultation with the Director of Medical Education, the Government have decided to permit employees, both serving and retired and also to their dependents, to secure treatment in the Private Hospitals recognised in the Government Orders 1st and 2nd read above, when the case is serious which requires immediate treatment and there is no sufficient time to get referral letter from Nizam's Institute of Medical Sciences, Hyderabad / Sri Venkateswara Institute of Medical Sciences, Tirupati. All the competent authorities are therefore permitted to sanction reimbursement of Medical expenses for the treatment at Private Hospitals recognised in the Government Orders 1st and 2nd read above after satisfying themselves that the patient was admitted in the hospital in a very serious condition and it was an emergency case and there was no sufficient time to obtain referral letter from Nizam's Institute of Medical Sciences, Hyderabad / Sri Venkateswara Institute of Medical Sciences, Tirupati if necessary after obtaining a certificate from the hospital to that effect and after obtaining copy of the case sheet. In all such cases of the treatment without referral letter, a 20% cut has to be imposed on the eligible amount after getting the bills scrutinised by the Director of Medical Education, Hyderabad.
  5. 5. All the Departments of Secretariat and all Heads of Departments are also informed that such cases covered under para 4 above need not be referred for relaxation and the authority competent to sanction the medical reimbursement can sanction such reimbursement in the above cases also. In all other cases where the competent authority though not satisfied with the alleged seriousness of the condition of the patient, but when the patients has obtained treatment at a private hospital directly on his own choice shall be referred to Government for relaxation when the Heads of Departments consider that there is genuine cause for anxiety and recommend for relaxation.
  6. 6. All Departments of the Secretariat and all Heads of Departments are informed that the rejected cases shall not be reopened and the cases pending as on the date of this order with the concerned competent authorities may be disposed of as per above order.
  7. 7. This order issues with the concurrence of Finance and Planning (Fin.EBS.VIII) Department vide theirU.O.No.2579/Fin.&Plg.(Expr.)/97, dated 3.5.1997.

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