ESIC reimbursement - took treatment for my father from a Private hospital in Pune without referring ESIC - CiteHR
Glidor
Hr Consultant
Sujit7008
Employee

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I have a query regarding ESIC, I am the worker took treatment for my father of Harniya and Prostrate Gland from a Private hospital in Pune without referring ESIC in last week, because of my ignorance towards ESI benefits, and he is listed in ESIC and his medical expenses are more than his paying capacity.
Now I want claim his medical expenses form ESI department as we are paying his contribution. is it possible to claim his expenses from ESIC in this case if yes than what is the complete procedure for this?

immediately visit your ESIC panel doctor and obtain referral. on his referral only, AMO will be in position to consider the reimbursement
Please share the claim form & list of required document
as you said he is hospitalized and can not pay pay bills, so you have to visit the panel doctor with your TIC your and his aadhar card, hospitalization documents and state t hat it was done emergency, and you did not got scope to get in touch with ESIC. by any means get his referral on your hospitalization documents, he will sign it an d send you to AMO, AMO will check the documents and handover a form ( not available online or to public by putting his signature on top, for onward submission to the hospital where he is admitted, they will fill the form and return in a sealed envelope (confidential) and you have to return the same to AMO, after receiving the same , AMO will express whether he will settle the bills directly or the reimbursement procedure.
everything is possible until the patient is not discharged, because nobody will make entry in back date, neither panel doctor, AMO nor hospital so do it immediately

if the hospital i s registered in ESIC panel list, direct payment is possible, and hospital will submit bills to ESIC, not the patient, provided the form reach them within time
Thanks for the kind information
I have a query regarding ESIC, I am the worker took treatment for my mother of Throat tones from a Private hospital in Jaipur without referring ESIC before 2 days, because of my ignorance towards ESI benefits, and he is listed in ESIC and his medical expenses are more than his paying capacity.
Now I want claim his medical expenses form ESI department as we are paying his contribution. is it possible to claim his expenses from ESIC in this case if yes than what is the complete procedure for this?

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