Industrial Relations And Labour Laws
Harsh Kumar Mehta
Consultant In Labour Laws/hr
Insolvency N Gst Professional
Ram K Navaratna
Hr Consultancy
Goutam Pradhan
Asst. Software Engineer

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Dear Sir/Madam,
My father was no more on 5th Nov 2014 due to Liver & heart problem. That time I was admitted my father to SUM Hospital in Odisha, which is ESI tie up medical. & My father under ESI Scheme also. I have medical bills & all documents. SO can anyone help me How to Reimbursement this? IS there any chance to get some help from ESI?
So please help me Sir/Madam, Actually I am running with lot of financial problem.
So please respond me & Kindly help.

From India, Bangalore
MR.GOUTHAM you have all medical bills & all documents . you are eligible for medical Reimbursement .first you have to approach to your dispensary they will give all information for medical reimbursement how to apply .
From India, Hyderabad
You cannot get reimbursement of medical expenses incurred for your father unless he was referred to private hospital by the ESI Medical Officer. Madhu.T.K
From India, Kannur
1. Sir, I fully agree with the views expressed by Sh. Madhu T.K.above. But I feel that a period of about 4 months have elapsed and you should have promptly contacted the concerned authorities.
2. I will suggest to please visit appropriate ESI dispensary and discuss the issue with them.

From India, Noida
Dear Sir(Madhu T.K.), But that private medical is coming under ESIC.
From India, Bangalore
1. Sir, ESIC has its own dispensaries and hospitals and therefore, in my opinion, will not favour referring each and every patient to other private hospitals where they have tie-up arrangements. However, ESIC has its own policies including referral policy for medical facilities. Accordingly, I have in my earlier comments suggested to contact appropriate ESIC Dispensary to which you are attached.
2. I am attaching herewith few circulars etc. indicating the policies of ESIC in medical benefit including its policies relating to referring the patients to tie-up hospitals. I hope, the same may be helpful to you or other readers of this citeHR. These instructions/circulars are available on the website of ESIC and can be downloaded by any person interested in the matter.
3. From these circulars etc., I think you can find and ascertain the procedure regarding reimbursement, if allowed, in the matter to which you wanted to know in this thread.

From India, Noida

Attached Files
File Type: pdf ESIC CIRCULAR 29-08-2014 REGARDING MEDICAL SERVICES.pdf (261.7 KB, 572 views)
File Type: pdf ESIC CIRCULAR 09-11-2011 REGARDING REFRRAL OF PATIENTS.pdf (1.29 MB, 266 views)
File Type: pdf ESIC OPERATIONAL MANUAL 2014 -SUPER SPECIALITY SERVICES.pdf (923.7 KB, 635 views)

Even for private hospital which are tied up with ESIC,there are certain referral procedures.
Other learned members have adviced you correctly and Mr Harish Kumar Mehta has attached some circulars which are useful.Read the circulars and get some information about whole process.
However you need to visit the ESIC office and discuss the whole matter.Further delay in meeting the officals on ground who will handle your case of reimbursement is the most important step.
People can advice you and guide you in this learned forum but you as claimant will have to do the legwork of meeting and discussing and finding out ways and means to get the reimbursement.

From India, Pune
Dont confuse on this. You just contaact your Esi branch manager. They will help u clearly as. What u have to do
From India
Sir, reimbursement of medical bills is not the subject matter of ESIC Branch Manager.
From India, Noida
Dear Gautam
1. With your all medical bills and the circumstances that made you to approach private dispensary and conditions of your patient make an application and approach Directorate of Medical-ESIC of your Region and submit. Every month esic will hold meet with such applications and committee examine and do the needful. Ascertain from medical directorate about venue time etc. and be present on the day with your copy of application and all related documents if possible patient also. Get recommendation letter from concerned employer and if possible dispensary also.
ESIC is richest organisation and they are very liberal in considering genuine cases and help. I am sure you succeed in this. Try without delay. All the best
Ram k Navaratna
HR Resonance
hrresonance at gmail dot com

From India, Bangalore
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