Guide line for ECHS Beneficiaries

Some of the mistakes being made by the veterans/ NOK/Families during medical emergencies and guide line to follow the correct action are given below for info please.
When someone is seriously sick or in an emergency NOK rushes the patient to nearest hosp not knowing if it is empanelled or not or if that EH is providing the required treatment or not. All EHs are not empanelled for all types of treatment.
NOK is more worried in getting the urgent medical attention, however, I have seen cases where in the patient has travelled a long distance to one of such EH and he has been told that such facility is not available or the MOA has expired or ECHS patients are/is not being entertained etc.,.

Guide Lines.

1. Always keep latest list of EHs in your ECHS note book apart from your smart phone.
2. Always carry your ECHS Card and keep it handy. Keep your Aadhar Card No in your mob. When one is going out of station do not carry echs card of your family members even by mistake. Use of Dig locker has already been explained.
3. In any emergency, always ring up the EH and find out if they are entertaining ECHS card holders, give out the symptoms of sickness/emergency, like, broken leg, fall and head injury, breathing problem, black out etc.,
4. Confirm that the EH can treat the sickness/emergency and are accepting the echs card beneficiaries. Intimate them your time of expected arrival. Keep the hops intimated if your travel is long haul more than an hour like five to six hours or more.
5. This action saves time and gives the EH to warn the specialist to be available when patient arrives at the hosp.
6. Only after confirmation move the patient to the hosp.
7. Follow the guide line/procedure published in this group in case of admission in EHs and Non EH and actions to be taken. This will avoid unwanted harassment in getting the reimbursement claim through.
8. Some EH may trick you to agree for providing bed on cash payment. Do not agree to payment at EH which is NOT reimbursable as per policy of ECHS.
9. If the EH is too far to go being in remote area and due to the condition of the patient being too serious, go to any hosp which is close by, get the patient stabilised, in the meanwhile get the Referral from PC by hand through some friends after speaking to OIC PC (if one cannot go personally). Tie up with the EH as stated earlier and move the patient by ambulance. Get all the bills, discharge summery, emergency certificate lab tests and all other docu from the hosp for claiming reimbursement for the duration for couple days for stabilizing the patient.
10. Do not convert planned treatment to look like an emergency case. It can easily be made out and one will not get any reimbursement. Instead take prior sanction. Same goes for non-listed procedure also.
11. When such emergencies occur when one is out of station please intimate the parent PC by WhatsApp msg as well as email giving details of emergency and details of admission with copy of ECHS card, Aadhar card Number and mob number. Similarly intimate the nearest PC. Keep this action as record.

Other general point of interest

1. If any procedure/ surgery/treatment are not available in your station or under your RC, prior approval/sanction can be obtained to get the treatment done even in a non EH on cash payment basis. In such cases entitled TA can also be claimed.
   (https://echs.gov.in/img/Policy/Medical/Advisory/Referral/Med7.pdf)
2. If desired treatment is not available in the city / town of the parent
   PC, patient can select any empanelled facility within the RC. TA will be
   Allowed only if selected city is the closest to the city/ town of parent PC.
   Even if desired treatment is available in parent city / town, patient can
   Select any Emp facility within RC but no TA will be admissible (para 23 H (ii) of SOP of 28 Sep 2018)
   For detailed policy on TA for treatment out of statin ref to echs policy letter No B/49783/AG/ECHS dt 17 Sep 18. At the hyper link given below:-
   https://echs.gov.in/img/Policy/PROC&FUND/Advt/TRAVELLING%20ALLOWANCE%20FOR%20ECHS%20PATIENTS.pdf
3. Advance for Treatment for Hosp of National Repute. To address the
   Concern of huge expenditure required to be incurred by the beneficiary while taking treatment in Govt Hosp/ Hosp of National Repute, advance up to 80% of likely expenditure can be provided to the individual for treatment. The amount will be paid to the treating hosp directly whereas balance amount can be claimed by the beneficiary after treatment is over. (Auth: CO ECHS letter No B/49773/AG/ECHS/Med Advance dt 16 Mar 2004). For full details please ref to para 41 of SOP dated 28 Sep 2018.
4. On discharge from EH after cashless treatment, please do not walk away in a hurry after blindly signing the papers. The amount of bill the hosp claims is to be checked. Patients must scrutinise the details of ward, medicines & other aspects which have been billed to them. It is our ‘budget’ and all ECHS patients should assist in arresting wrong and excessive
5. In case of emergencies Hospitals should desist from generating wrong emergencies as the same will invite strict action. In case of doubtful cases, the benefit of doubt must be passed on to the patients. (Para 46 of SOP)
6. Domiciliary Medical Eqpt. Procedure for procurement and issue of
   Domiciliary medical eqpt has been issued vide CO ECHS letter No
   B/49761/AGECHS/Policy dt 31 May 18 and letter No B/49762/AG/ECHS dt 31 Jul 18. SEMO is currently responsible for issue of domiciliary eqpt. See the details at the link given below:-
   https://echs.gov.in/img/Policy/Medical/Policy/medicine%20&%20eqpts/ISSUE%20OF%20DOMICILIARY%20EQPT.pdf
7. Domiciliary Rehabilitation / Terminal Care. Rehabilitation/terminal care will be provided in empanelled rehabilitative homes and hospices. Patients admitted to Service hospitals or empanelled hospitals/ nursing homes, however, when the finality of treatment has been reached and definitive medical treatment has run its course, will be referred to rehabilitative homes/ hospices for terminal care and rehabilitation. The conditions for which rehabilitative care will be admissible will be paraplegia, quadriplegia, Alzheimer’s disease, cerebro-vascular accidents, other neurological and degenerative disorders, amputations, cancer terminal care and other such medical conditions when duly referred by treating specialists. Approval of SEMO/SMO/PMO/CO ECHS will be obtained for these referrals.

Reimbursement will be limited to maximum period of 6 months. Thereafter
Cost of such care has to be borne by the ECHS beneficiary.

Many veterans are not aware that we in Bangalore/Karnataka are helping the veterans on WhatsApp by volunteers. Unfortunately this is not so in most of the other states and cities. I have also come across veterans who do have emails ids they not even own a smart phone and they are not in touch with any procedures and changes in policy. They have got into problems by not knowing the procedure for such emergencies. There are many veterans and families who are still not aware that they have to apply for 64kb card on line but are happily/merrily going around with 16kb card which is not in use. (the dead line now has been extended to Jun 2021). Many such patients have paid from their children’s insurance which could have been avoided.
Members are requested to kindly circulate msgs/guide line to others in your circle/ friends/course mates etc…