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Rs 15 lakh aid for treatments out of Ayushman cover

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Dr KK Aggarwal    12 February 2020

HT Excerpts: In 2017-18, Rs 40 crores were used from the Rashtriya Arogya Nidhi funds at AIIMS, Delhi for providing free treatment to 926 people, approximately 4.31 lakhs per patient, according to the latest annual report from the hospital.

Poor patients in need of expensive treatment not covered by packages under the Ayushman Bharat insurance scheme will now again be able to get financial assistance of up to Rs 15 lakh under the Rashtriya Arogya Nidhi (RAN) scheme.

 The beneficiaries of Ayushman Bharat scheme in need of expensive surgeries like organ and bone marrow transplants, spine surgeries, and revision surgeries for faulty joints became ineligible for assistance under RAN after the guidelines were revised in February last year.

 In January, the Delhi High Court had directed AIIMS to treat a poor 11-year-old boy with aplastic anemia for free, with the Central Government reimbursing the cost of treatment, as the disease is not covered under the Central Government’s flagship Ayushman Bharat scheme. This had opened up the way for other patients to approach the court to get financial aid. However, the change in guidelines is a big relief.

I raised this issue on 25th December, 2019

PMOPG/E/2019/0725773

Name Of Complainant

Dr K K Aggarwal, 25/12/2019

Prime Minister’s Office

Discrepancies in Ayushman Bharat and Rashtriya Arogya Nidhi Schemes

Dr KK Aggarwal, President CMAAO and HCFI

I saw a report of Rema Nagarajan in TOI that a 12 years old Sameer from Bihar’s Muzaffarpur is suffering from aplastic anemia, needs Rs 12 lakh for a bone marrow transplant but in spite of being entitled under both Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and Rashtriya Arogya Nidhi (RAN), he is getting no relief.

The hurdles are that Ayushman Bharat does not cover bone marrow transplant and an office order says that he cannot be covered under Rashtriya Arogya Nidhi (which provides up to Rs 15 lakh coverage for serious illnesses) because he is covered under Ayushman.

The job of the government is to help and not find the loopholes. Government orders cannot supersede the spirit behind the schemes. Its’ like that the rules cannot supersede the act.

I have another patient Mithilesh Kumar from Bokaro, Jharkhand. He is a contract worker. He was operated for implantation of CRTD St. Jude Device pacemaker at CMC, Vellore in 2014. At that time, he managed to arrange the amount for operation by selling his property. Now, battery of the pacemaker is to be replaced. He has Ayushman Bharat card, but it does not cover the expenses of battery replacement. He has written to PM, Narendra Modi for help.

Not covering the battery replacement does not make sense. If you have decided to cover a pacemaker it is understood that the battery would last 5-15 years depending on the type of device and second or third replacement needs to be covered.

Where should a poor man go for the clarifications? Courts are already overloaded with cases. Everyone cannot afford the courts also. Such powers should be given to District Magistrate or the CMO to handle and interpret the government orders in the right spirit.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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