ESIC reimbursement for 8 year old daughter's surgery - less than 50% of my claimed amount - CiteHR
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I have submitted the my 8yrs old daughter private hospital bills of Rs- 8,98,810/- on 02.02.2019 for this they have made the reimbursement of Rs- 4,29,103/-. Which is lesser than 50% of my claimed amount.
Here I will write brief history
My daughter was suffering from multi focal epilepsy since 7 yrs. we have shown to various Neurologist including NIMHANS Banglore in last 7 yrs. Finally with reference of our relative ( he is Neuro surgen in same hospital) consulted KIMS secundrabad they have diagnosed the exact problem & suggested for surgery. the surgery is 2 phase 1st one is Sterio Video EEG( to detect the exact location of damaged brain part) & 2nd one is to remove the part. For this they gave around 10-12 lack estimation. along with estimation letter & request for permission letter I have met our local ESI hospital superintendent, they said we can't give interstate treatment permission ( KIMS secundrabad) you have to take treatment within state with our tie up hospital. For this I have searched the hospitals which has the facility of above mentioned surgery, but there is no ESIC tie up hospital having this surgery facility. then our Hubli ESI hospital forward the my request letter along with sugery estimation letter to Regional Director office Banglore.
I am personally took the forwarded letter & met the State Medical officer in RD office Banglore along with all medical reports in June 2018. There they also enquired about the surgery with various ESI tie up private hospital. But there is no facility available in Banglore also. Initially they are not approved for the treatment because interstate. In mean my daughter condition was getting panic I started regular follow up regarding permission. One day State medical officer called to my cell & said you can take the treatment I will try to reimbursement around 75%. We went for 1st phase sugery in Setember - 2018 & 2nd Phase in January 2019 & submitted the bill in Feb- 2019.
After receiving less amount I have called to State Medical Officer, he said after my all effort they have made the reimbursement according to Govt rate, & this is my max help I can do. Now Its injustice with me. Because the treatment was taken is not there in any Govt hospital & with ESIC tie up hospital in my state.
I have 7 yrs old all medical document in that 2 -3 Neurosurgen suggested the surgery, one of Neurosurgeon mentioned that this patient need Sterio type surgery & this facility is not available in Entire North Karnatak.
Even I have consulted many Bangalore hospital regarding this surgery in E mail. They have replied with NO FACILITY AVAILABLE.
Now suggest me how can fight for this.

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