The ECHS cell of the IESM was created a few months ago, to permit the IESM help Veterans in their dealings with Polyclinics, Hospitals etc. We had hoped to create a chain parallel to the organisational structure of the ECHS ,so that we could interact with all levels of the ECHS hierarchy. There are 297 polyclinics and 13 Regional Centres across the Country;and many more will be coming up in the future. Despite numerous requests we have only a handful of volunteers at Regional and Polyclinic level. These volunteers are also restricted to Veterans from metropolises and that too mostly officers. The most affected group of Veterans ie those in rural areas and amongst PBORs continues to be unrepresented.
May I please request rural based ESM to volunteer their services to the ECHS cell of IESM. All you need is an Internet connection, some time and a desire to be of some help to yourself and brother Veterans. Every village should have an Internet connection even if it is shared. If the volunteer Veteran does not know how to handle a computer maybe his grand son will help out. A cyber cafe based computer will do quite well.
All the help we have been able to provide so far is restricted to officers who have interacted with us - NOT one JCO, NCO or OR except a Delhi based Sgt who is net savvy. Even amongst officers the knowledge of rules governing the ECHS is inadequate- resulting in much heartburn when a crisis situation occurs. In a nut shell and briefly the following knowledge base should help.
In routine cases.
Report to reception at your parent Polyclinic with the ECHS smart card and treatment book- move to the concerned Dr-and proceed to draw medicines as prescribed- or take a referral form for the empanelled hospital-proceed after referral to the empanelled hospital-visit consultant-and follow treatment.
At Empanelled hospital.
Follow treatment as advised. Empanelled Hospitals CANNOT provide Out Patient Treatment .They will either send you back to the Polyclinic for carrying out the tests and further OPD treatment or ADMIT you. If admitted they will follow through with tests and treatment as required. DO NOT MAKE ANY PAYMENT TO EMPANELLED HOSPITALS UNDER ANY CIRCUMSTANCE.PAYMENT IF MADE WILL NOT BE REFUNDED. When taking a referral from the polyclinic ask the Dr concerned at the polyclinic to refer you for (A) Consultation (B) Required Tests (C) Admission. IF YOU GO FOR ONLY CONSULTATION THEN YOU WILL MAKE NUMEROUS TRIPS BETWEEN POLYCLINIC AND EMPANELLED HOSP.
IN EMERGENCY.
Report to nearest empanelled hosp.
Tell hosp you are an ECHS patient- Get an emergency cert from the empanelled hosp.
INFORM IESM REGIONAL LIAISON CENTRE REP OR IESM POLYCLINIC LIAISON CENTRE REP ON PHONE OR EMAIL.
Get treated after admission.
At the earliest opportunity inform the Polyclinic handling the empanelled hosp and give copy of Emergency certificate that you have obtained from the Hosp.
The Polyclinic will give you an Emergency referral which the empanelled hosp will use for its claims. As per rules the empanelled hosp is required to do the running around. They seldom do. DO NOT MAKE ANY PAYMENT TO THE EMPANELLED HOSP. YOU WILL NOT GET A REFUND.
In an emergency if you are forced to go to a non empanelled hosp-Go-get admitted-get an emergency cert from the hosp-inform nearest polyclinic.
INFORM IESM RLC OR PLC REP-obtain Emergency Information Report from the nearest polyclinic-clear hosp bills yourself -take original hosp bills,investigation reports,bill summary, discharge summary and emergency cert from the non empanelled hosp and submit claim for reimbursement to your parent polyclinic who will process your claim-send it to SEMO-Sta HQ-Regional Centre/ Area HQ - Command HQ or whatever level is authorised depending upon amount to be reimbursed.
YOU WILL BE REIMBURSED ONLY ECHS RATES WHICH ARE MUCH LOWER THAN THE RATES THE NON EMPANELLED HOSP WILL CHARGE YOU.
Some cases handled by the IESM to date will help illustrate the system.
One.An Admirals reimbursement had not been paid for over two years despite everything being in order. Cleared after IESM intervention.
Two. A Pune based empanelled hospital forced a lady to clear hospital bills on the demise of her husband stating that ECHS took too long to clear their bills. They refused to release the body. The rates charged were commercial and NOT ECHS rates. The lady who was already handling a bereavement cleared the bills. The hosp claimed the amount from ECHS-got echs rates and repaid the lady ECHS rates. The Hosp was cheating on numerous counts. IESM is pursuing the case with Central Org ECHS and disciplinary action is being taken against the Hosp.
A veteran from Dubai who is an ECHS member wanted to get a Total Knee Replacement done from a non empanelled Hosp in Ahmedabad. He approached us at the IESM. We obtained special permission for him to go to the non empanelled hospital pay the Hospital rates and claim ECHS rates. The Veteran was willing to foot the difference. He has undergone the surgery and is still recuperating in the Ahmedabad hospital. Our RLC and PLC reps handled the Regional Centre at Pune and Polyclinic at Ahmadabad; whilst we at the ECHS Divisional level obtained the special sanction from MD ECHS.
There are a few other cases too but these are all offr level cases. We have not been able to reach out to our Veterans in remote areas. Our reach is also restd to Delhi/ NCR/ Chandigarh/ Pune/ Mumbai/ Chennai etc. Himachal, Uttranchal, UP, Rajasthan, Bihar, West Bengal NE States do not have any representation. WE NEED REPS AT EVERY POLYCLINIC IN THE COUNTRY. Those responding to this appeal kindly get in touch with the IESM ECHS Cell at http://www.iesm.org/
Brig Sateesh Kuthiala (Retd)
No comments:
Post a Comment