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To ,

This is to inform you that I am a DGHES


The secetary ,
Delhi medical council , pensioner (card no.20546 ) (T.R.S No. 642887
maulana azad medical
entitled to receive cashless treatment as per the
IP Estate Delhi
norms of DGEHS . I have been deceived and
Complainant's Details :
induced into paying an additional amount of Rs
NAME :Baldev raj (retired pensioner 36,225 by the hospital (bill no.16018126) at the
GNCTD ) and an empanelled DGEHS life
time of discharge on 01-08-2016 when I
time member hence eligible to receive
cashless treatment from DGEHS along with my wife and son were
empalelled hospital . physically restrained and asked to cough up the
Address : said amount without which would not go home.

House no. 28 , Road no.45,


Punjabi bagh (West), That I was admitted on contingency basis at the
New Delhi-110026 said hospital which is empanelled with DGEHS.
Disease : CAS ( TYPE III ). After the necessary formalities & having shown a
valid DGEHS card I was taken to the heart
PROCEDURE UNDERGONE :
command centre.The operating physician called
Angiography , thrombus busted, my attending son to say that his father has to
balooning followed by cobalt chromium
stent implant in LAD . undergo PCI for which a coronary stent shall be
inserted in his coronary artery. He further told
______________________________________
him that the coronary stents as recommended
Opposite parties details : by DGHES involves substantial risk to a patients

Maharaja Agarsen Hospital , life who thereafter have no guarantee of recovery


Punjabi bagh West , Also he stated that the DGEHS and govt. approved
New Delhi-26.
stents are prone to cause or be associated with
Name of Physicians associated with MAH sudden loss of B.P and sometimes the pulse goes
1. Dr. Vineet malik
2. Dr. Pramod Jain missing .Having heard this statement coming
______________________________________ from the mouth of a qualified physician the
Where patient/applicant was kept for post
attendant panicked and and under duress/distress
surgical monitoring :
asked the physician to provide the best of
Ward No. HC7
treatment which a patient is entitled to receive
________________________________________
FACTS ASSOCIATED WITH THE CASE from a physician and do whatever he feels right is
OR in the intrest of the life and safety of his patient.
CAUSE OF ACTION
On the first of august 2016 , at the
Honorable SIR/MADAM , time of discharge , I was restrained to go home
unless having paid Rs.36225 bill no 408677 dt 01- of the product given to DGEHS by the
08-2016 . I vehemtly urged them that I am a hospital for the reimbursement is of
DGEHS beneficiary and a pensioner & since the DRUG(Serolimus) ELUTING CORONARY
treatment is meant to be cashless hence there is no STENT (BIOTRONIK) with Batch no. as
point in asking for money but they didn't listen . mentioned in sticker on its back is 11154513-39
My wife who is a cancer patient herself collected for illegally getting an additional Rs 11625 which
the said amount in a very difficult circumstances , is the difference b/w a cobalt chromium and a drug
and after making the payment they allowed me to eluting stent (DGEHS ) ceiling rates.
leave. You are requested to ask them to refund me More-over the PCAR report given to me shows T
the money and a stict action may kindly be taken the different stent system components under
different heads as :-
YOU ARE REQUESTED TO TAKE AN (a) GUIDE WIRE USED (WHISPER)
APPROPRIATE STRICT ACTION AGAINST length=180 cm whereas on the stent system
MAHARAJA AGRSEN HOSPITAL PUNJABI mentioned wire length is 140 cm .But in actual
BAGH whisper has a wire length of 190 cm.
(b) Stent dimensions as mentioned in PCAR
It is pertinent to mention that for angioplasty , 32.5X35 mm Orsiro ( model no. not mentioned)
the OPERATING physician implanted a cobalt whereas Stent dimensions on product wrapper
CHROMIUM bare coronary stent in my LAD to DGEHS for reimbursement 2.5 X 35 mm.
(LEFT ANTERIOR DESCENDING ) for which It is also worthwhile to mention that guide wire
the ceiling rate as per DGEHS is Rs.12000 only . also a part and included in the stent system
But the hospital has raised a bill claiming of Using two guide wires of different brands
having implanted me (I.P No. 1629507) with a having different lengths for a single procedure
Drug Eluting Stent (Serolimus Eluting coronary (dialatation and thrombosuction ) is untenable.
stent system batch no. 11154513)(2.5X35mm)
Orsiro for receiving a reimbursement amount of
Rs. 23625
If for.This
one DGEHS
information
patient
came
theywithin
chargedmy
Rs. 36225+13000 extra , the esteemed yourself may
knowledge
calculate
as i the
noticed
magnamous
it beingamount
handwritten
accumulated
in- by unholy, unjust way which deliberately
patientremained
hospital record
unaccounted
file HC7
for kept
as they
for have
patient
been charging extra per head inspite of being aware of
drug regimen
the fact that
or treatment
coronary stents
schedule
are included
including
as d r u g s b y N P P A u n d e r D P C O as
details of doctors visits in which artial sheath
removal
b atime
c k i@4
n 2pm
0 0written
5 t h r and
o u galong
h n owith
tification no S.O.1468 (E) dt. 06-1
mentioned that the type of stent implanted
biomatrix cobalt chromium bare stent
(2.5x35)
2 0 whereas
0 5 . Whereas
the stent
nowcover
it hasand
alsothecome
sticker
under the list of Essential Medicines for which price
t of India and not by any physician who is intending to

oronay stent system(for reimbursement) sent to you

ny authorization or certification mark or any word

me on the stent cover box is written by the hospital


1. Copy of emergency certificate of patient. P 1
ndant.

KE OVER THE HOSPITAL AND MAKE IT AN IDEAL


3. Copy of my valid DGEHS CARD no . 20546. P 3

4. Copy of the bill receipt amount = Rs 36225 receipt no.408677 dt 01-08-16.P4

6. Copy of CoronaryAmount
Angiography
= 36,225
Report. P7- P8

IP NO. 1629507
8. Copy of the cover of the stent box and cover sent to DGEHS by hospital

9. Copy of the gate pass behind which the bill amount to pay then only the guard to allow a

10. Copy of FINAL RECEIPT as printed behind the gate pass not crossed.P13
16-2-15 file no. 13(01)/2015/Div-III/NPPA./14

um by Govt NCT Delhi regarding ceiling /15 rates fixed for


GEHS members.