RS Bima Yojana, claims must be settled

Mangalore Today News Network

Mangaluru, July 29, 2015 :  Chairing a meeting of RSBY - Rashtriya Swasthya Bima Yojana  implementation in Dakshina Kannada district,  DK DC Adoor B Ibrahim directed the private sector General Insurance Company to settle pending claims under Rashtriya Swasthya Bima Yojana (RSBY), before August 10 and also restore empaneled service under the scheme with Fr Muller’s Hospital in Mangaluru.

Three hospitals have withdrawn from the RSBY, due to delay officials said. As on July 15, claims worth Rs 26,88,413 were pending to be settled.

The number of beneficiaries treated is 2,365 and claims worth Rs 80,16,400 have been settled. As per the guidelines, the claims have to be settled within 15 to 30 days.

The DC said grievances of private hospitals should be fulfilled by the insurance company. A delay in settling the claims by three to six months, will force the hospitals to withdraw from the scheme, he said.   The DC also directed the Assistant Labor Commissioner to convene a meeting of empanelled hospitals and insurance agency every month to resolve the grievances.

He also urged to empanel more super speciality hospitals in Mangaluru and Puttur under the scheme.   Assistant Labour Commissioner Nagesh said target for the district under RSBY was 3,16,529 with 2,174,73 BPL card holders, 98,787 beedi workers and 269 weavers, of which, 1,25,085 BPL card holders, 13,298 beedi workers and 67 weavers have been registered. He said under the scheme, beneficiaries would enable them to get cashless treatment up to Rs. 30,000 a year. It is a cashless treatment for 1516 procedures.

A representative from KVG hospital, Sullia said claims worth Rs 14 lakh was pending. He also alleged that the insurance officials misbehaved in the female ward of the hospital where the chairman of the hospital was treating the patients.

However, representatives from insurance refuted the charges. To avoid such misunderstanding, the DC directed all the hospitals empanelled under RSBY to designate a person to coordinate with the insurance authorities.  The insurance representative said patients should produce their smart card issued under RSBY within 24 hours of admission in the hospital, to avoid any problem in settling the claims.

The insurance authorities claimed that the settlements were delayed when the hospital authorities failed to submit all the documents for verification during the surprise auditing in the hospitals.