Shri.

Sushant Upendra Panda,

F3063M/ Foreman,
C 41 / BEF Dept.
Naval Dockyard,
Mumbai :400 023

25 June 2018

To,
The Admiral Superintendent,
[For AGM (P&A)],
Naval Dockyard,
Mumbai : 400 023

Respected Sir,

(Through proper channel)

FINAL SETTLEMENT OF MEDICAL REIMBURSMENT CLAIM IN RESPECT TO

MASTER SURAJ PANDA, S/O SHRI. SUSHANT PANDA, F3063M, FM, CNO.40

1. Refer to the medical reimbursement and final settlement claim in respect of my

son Master Suraj Panda of Rs. 53,879/- (including Rs.45, 200/- Bill by Sapna Health
Care Centre Pvt. Ltd & Rs. 8679/- of medicine bills) submitted along with all original
documents to your office.

2. It is on record that I had received Rs. 20,200/- on 31st Aug 2017 as medical
advance for the treatment of ‘RADIUS ULNA DISTAL 3 rd with Debridment of compound
wound’ paid through ECS to Sapna Health Care Centre Pvt. Ltd. Ghatkopar, a CGHS
Empanelled hospital. Also I have received the final settlement and medical
reimbursement amount of Rs. 7,029/- on 17th Feb 2018 after the above said
submission.

3. It is evident from the above that Rs. 26,650/- are disallowed and not reimbursed
at the time of the settlement of the claim. It is pertinent to highlight that the patient (my
son) was admitted at CGHS empanelled Sapna Health Care Centre Pvt. Ltd at
Ghatkopar, inspite of the emergency case (Certificate from hospital submitted) and my
residence at Wadala. Also I have followed process and intimated my office to obtain the
medical advance and references from the appropriate authority.

4. I have made many verbal enquiries to understand the reason behind disallowing
Rs.26,650/- despite of the submission of itemized bill from the empanelled hospital.
Many times my queries were not attended, but it was told me that the PCDA has
decided your bill so enquire at the same office. On enquiry at PM department and PCDA
office, it was told that the charges taken for the ‘Debridment of wound’ are not as per
CGHS coded rates and there are always some deductions after submission of bill
during final reimbursement.

5. On the aforesaid situation, a deadlock was observed since no answer was

available with me to counter the replies of the PCDA authority that is contradicting to the
assurance given by the Sapna Hospital administration that the said charges (without
CGHS Code head) will be reimbursed from your office as part of the memorandum of
understanding between CGHS empanelled hospital and administration to settle all bills.
The Sapna Hospital authorities told me not to create unnecessary scene and disturb in
their routine work to which I have to abide being a responsible government employee.

6. Refer to page 2 of the final bill no.934 dated 24 th Aug 2017, the Bed charges
were discounted by Rs.4,344/- from total bed charges only after protest for excess
charging of Rs.3,000/- per day against CGHS rates. It was during the final bill at
hospital I have asked why the CGHS code head not reflected on the item ‘Debridment
by Dr. Amin Shah’, for which Rs. 20,000/- are being charged and why the same charge
is not as per CGHS rates. The concerned admin person (Miss Simi) of the hospital had
coerced me to pay the bill generated otherwise no discharge of patient from the hospital
will happen. Also Miss Simi was not ready to accept the ECS memorandum received
from PCDA for advance payment of Rs. 20,200/- and forcing me to pay from my pocket
or wait till final clearance of money at their bank account. On complain by my
colleagues at CMO Dockyard office and only after interference by CMO Dockyard they
accepted to deduct the advance from final bill.

7. On my contentions to provide charges as per the CGHS rates, Miss Simi told me
that these are our rates and the same will be reimbursed from your office and not a
single claim has been returned. I found these are exorbitant therefore I had contacted
O/o CMO Dockyard also, but I was told to pay the bill and get discharged, and file
reimbursement for the same. The patient was discharged in the evening instead of
morning due to the whole drama and my family had to stay there till the payment done.

8. It is not understood how to get back the said disallowed money spent for the
medical treatment under CGHS scheme at empanelled hospital. It was none of my
mistake or error to take burden of the said amount as I had followed the proper
procedure of treatment. However I was compelled to pay the bill in order to get
discharge from the hospital and face embarrassment in front of my family. it is liability
either of hospital or the CGHS scheme. Since nowhere it was mentioned and informed
that empanelled hospital can/may charge exorbitantly under the CGHS scheme and
Naval Dockyard will not take cognizance of the same. I found cheated by the both
Hospital as well as CGHS scheme in the said case.

9. In view of the above, the case is submitted to your kind office for necessary
action at your end so as to award justice in my case, and reimburse the money spent for
the treatment.

Sincerely,

(Shri. Sushant U. Panda)