CGHS Hospitals – Getting treatment in emergency conditions
Under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialties…
Private hospitals have been empanelled under CGHS only for such specialties for which they are eligible as per the terms and conditions of empanelment. However under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialties.
“Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the earliest opportunity would be detrimental to the health of the patient or shall jeopardize the life of the patient".
CGHS beneficiary attending hospital in emergency: In such a situation the Hospital shall intimate to BCA within 2 hours of admission and BCA shall respond in 4 hours (however treatment shall not be denied to any CGHS member and this is only an initiation of the e-workflow). Post discharge hospital would upload bills and download documents as per requirements of CGHS within 72 hours.
TREATMENT IN EMERGENCY
In emergency the hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing CGHS facilities, on production of a valid CGHS card and the hospital shall submit the bill for reimbursement to the concerned Deptt. / Ministry / CGHS. The refusal to provide the treatment to bonafide CGHS beneficiaries in emergency cases without valid ground would attract disqualification for continuation of empanelment.
The following ailments may be treated as emergency which is illustrative only and not exhaustive, depending on the condition of the patient :
Acute Coronary Syndromes (Coronary Artery Bye-pass Graft / Percutaneous, Transluminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra Ventricular Tachycardia, Cardiac Temponade, Acute Left Ventricular Failure / Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stoke Adam attack, Acute Aortic Dissection.
Acute Limb Ischemia, Rupture of Aneurysm, Medical and Surgical shock and peripheral circulatory failure. Cerebro-Vascular attack-Stokes, Sudden unconsciousness, Head injury, Respiratory failure, decompensated lung disease, Cerebro-Meningeal Infections, Convulsions, Acute Paralysis, Acute Visual loss.
Acute Abdomen pain.
Road Traffic Accidents / with injuries including fall. Severe
Hemorrhage due to any cause.
Acute poisoning.
Acute Renal Failure.
Acute abdomen pain in female including acute Obstetrical and Gynecological emergencies.
Electric shock.
Any other life threatening condition.
Source: CGEN.in
Under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialties…
Private hospitals have been empanelled under CGHS only for such specialties for which they are eligible as per the terms and conditions of empanelment. However under emergency conditions, the empanelled hospitals are expected to provide treatment of CGHS beneficiaries in all available specialties.
“Emergency” shall mean any condition or symptom resulting from any cause, arising suddenly and if not treated at the earliest opportunity would be detrimental to the health of the patient or shall jeopardize the life of the patient".
CGHS beneficiary attending hospital in emergency: In such a situation the Hospital shall intimate to BCA within 2 hours of admission and BCA shall respond in 4 hours (however treatment shall not be denied to any CGHS member and this is only an initiation of the e-workflow). Post discharge hospital would upload bills and download documents as per requirements of CGHS within 72 hours.
TREATMENT IN EMERGENCY
In emergency the hospital shall not refuse admission or demand an advance payment from the beneficiary or his family member and shall provide credit facilities to the patient whether the patient is a serving employee or a pensioner availing CGHS facilities, on production of a valid CGHS card and the hospital shall submit the bill for reimbursement to the concerned Deptt. / Ministry / CGHS. The refusal to provide the treatment to bonafide CGHS beneficiaries in emergency cases without valid ground would attract disqualification for continuation of empanelment.
The following ailments may be treated as emergency which is illustrative only and not exhaustive, depending on the condition of the patient :
Acute Coronary Syndromes (Coronary Artery Bye-pass Graft / Percutaneous, Transluminal Coronary Angioplasty) including Myocardial Infarction, Unstable Angina, Ventricular Arrhythmias, Paroxysmal Supra Ventricular Tachycardia, Cardiac Temponade, Acute Left Ventricular Failure / Severe Congestive Cardiac Failure, Accelerated Hypertension, Complete Heart Block and Stoke Adam attack, Acute Aortic Dissection.
Acute Limb Ischemia, Rupture of Aneurysm, Medical and Surgical shock and peripheral circulatory failure. Cerebro-Vascular attack-Stokes, Sudden unconsciousness, Head injury, Respiratory failure, decompensated lung disease, Cerebro-Meningeal Infections, Convulsions, Acute Paralysis, Acute Visual loss.
Acute Abdomen pain.
Road Traffic Accidents / with injuries including fall. Severe
Hemorrhage due to any cause.
Acute poisoning.
Acute Renal Failure.
Acute abdomen pain in female including acute Obstetrical and Gynecological emergencies.
Electric shock.
Any other life threatening condition.
Source: CGEN.in
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