PS BIST Vs. UOI

JUDGEMENT

(1.) The petitioner before this Court is a retired Government servant entitled to benefits of Central Government Health Scheme (CGHS). The case of the petitioner, as set out in the writ petition, is that on 08.03.2008, he along with his wife was going to Sarojini Nagar to meet his daughter, who was staying there and on way to Sarojini Nagar when he reached near Saket, he felt uneasy, had severe pain in the head and was taken by his wife to the nearby Max Super Speciality Hospital, Saket, where he was admitted in emergency. An MRI Angiogram of the petitioner was done, which revealed MCA bifurcation aneurysm with mild tortuousity of the aortic rash. The petitioner was diagnosed as SAH due to ruptured Right MCA with right temporal hematoma. The petitioner was operated upon in the aforesaid hospital and was discharged on 13.03.2008. The petitioner paid a sum of Rs.2,10,638.98/- to the aforesaid hospital for his treatment during the aforesaid period.

(2.) On discharge from the hospital, the petitioner submitted a bill to CGHS Dispensary at Sarojini Nagar, seeking reimbursement of the expenses incurred by him. The claim of the petitioner, however, was accepted only to the extent of Rs 61,145/-, which according to the respondent, was the CGHS rate approved for treatment taken by the petitioner. The petitioner made a representation to the Additional Director of CGHS against the limited reimbursement made to him. The said representation, however, yielded no result which constrained the petitioner to file this writ petition seeking the following relief:-

(3.) In their counter-affidavit, the respondents have stated that the Ministry of Health and Family Welfare has approved the rate list vide OM dated 07.09.2001 to settle the medical claim in respect of CGHS beneficiaries. Such package rate is a lump sum cost of inpatient treatment or Diagnostic procedure for which a patient has been referred by Compete Authority or CGHS to Hospital or Diagnostic Centre and includes all charges pertaining to a particular treatment/procedure including, accommodation charges, ICU/ICCI charges, monitoring charges, procedural charges/Surgeon's fee, cost of disposable, surgical charges and cost of medicine used during hospitalization, related routine investigations, physiotherapy charges etc. It is further stated in the counter-affidavit that the petitioner chose to go to Max Super Speciality Hospital though he could have gone to AIIMS/Safdarjung Hospital, which was much closure. It would be pertinent to note that Max Super Speciality Hospital is not a hospital empanelled by CGHS.