RATTAN LAL GUPTA Vs. UOI

JUDGEMENT

(1.) Petitioner retired as a Civilian Staff Officer from the Ministry of Defence, Central Government and is getting a regular pension. Being a retired Central Government employee, the petitioner is a life beneficiary of the Central Government Health Services (CGHS) Scheme. A copy of the CGHS card issued in favour of the petitioner is annexed with the petition. It is stated that on 29.08.2003, the Director (CGHS) had granted permission to the petitioner for implantation of the Pacemaker (dual chamber) through Apollo Hospital, Sarita Vihar, New Delhi. The petitioner was admitted in the said Hospital on 30.08.2003 and the Pacemaker (dual chamber) was implanted on the same day. The petitioner was discharged on 02.09.2003. At the time of discharge from the hospital, the petitioner was handed over a bill amounting to Rs.1,82,650/- and was asked to pay Rs.45,830/- as the hospital could claim only Rs.1,36,820/- from the CGHS as a result of which petitioner had to pay Rs.45,830/- from his pocket. The said amount was paid by the petitioner as there was a difference between the actual cost of the pacemaker implanted and the cost of the pacemaker permitted by CGHS. Further, the bill also included Rs.16,160/- towards procedural cost of pacemaker also. The doctor who had implanted the pacemaker had also given a certificate to the effect that the pacemaker implanted was an essential one for the proper treatment of the petitioner. Petitioner made a representation dated 29.09.2003 claiming the said amount from respondent. Respondent sent a cheque of Rs.16,160/- only to the petitioner against the reimbursement of Rs.45,830/-.

(2.) By way of present petition, the petitioner has prayed for an issuance of a writ of Mandamus/any other order directing the respondent to pay the balance amount of Rs.29,220/-, paid by the petitioner to the hospital incurred in the implantation of Pacemaker (dual chamber) along with interest @ 12% p.a. with cost of litigation.

(3.) Respondent has opposed the present petition by filing a reply wherein it is admitted that the petitioner underwent implantation of Pacemaker (dual chamber) in Apollo Hospital after taking approval from Director (CGHS). It is stated that the ceiling for the Pacemaker (dual chamber) is Rs.1,15,000/- as per O.M. dated 12.06.1996. The said amount was reimbursed to Apollo Hospital. The package rate for procedure of implantation is Rs.16,160/- and the same is also the approved rate which is also reimbursed to the petitioner. The stand of the respondent is that reimbursement is done as per CGHS rates as such nothing is due for payment to the petitioner. It is stated that the difference of the amount over and above the CGHS rate was to be borne by the beneficiary himself.