APOLLO BGS HOSPITALS, MYSORE

Maternity Estimation 2020-2021

PATIENT NAME: DATE: CATEGORY:
DOCTOR NAME: UHID NO. /IP NO: OPTED ROOM:
MOTHER CHARGES
WARD CATEGORY NORMAL DELIVERY(UPTO 2DAYS) LSCS (UPTO 4DAYS)
STANDRAD 50,000 75,000
SPECIAL NON AC 65,000 90,000
DELUX 80,000 1,10,000
PLATINUM 1,00,000 1,30,000
PLATINUM SUITE 1,20,000 1,75,000
ICU CARE AT ACTUAL COST AT ACTUAL COST

BABY CHRGES
WELL BABY 20,000/-
ICU CARE- Pre Matured/any clinical examination AT ACTUAL COST
GENARAL INCLUSION-KINDLY READ
 Professional Fee OT TOWARDS BABY
 OT Charges * Cradle Charges
 Regular Visit Fee from the consultants. * Paediatric Dr visit Charges
 O.T and Ward Medicine and Consumables. * Nursing Charges + Monitoring charges
 Bed Charges * Vaccination, 5HP, NEONATAL HEARING
 Medical administration and nutrition assessment charges SCREENING, BLOOD GROUPING AND TYPING,

GENARAL EXCLUSION- KINDLY READ

 Above estimated amount is for elective cases only, in general holidays and late night emergency
RS.10,000/- will be charged additionally. Any Infected Cases/Pre Evaluation Investigations,
Emergency admission and evaluation charges are additional.
 If patient require CT, MRI scan, any other Diagnostic investigation, Bedside procedure, higher value
medicines, surgical instruments, blood transfusion, cross consolation etc charges will be at actual as
advised by treating Doctor. Hospitalization charges will be varying according to the occupied room, except
Pharmacy and Implants. If any complication posts surgery/Clinical condition of the Patient, the charges will
differ.
NOTE- KINDLY READ:
100% payment to be done in the billing Department and receipt to be collected Before Medical/surgery Clearance
 Hospitalization charges will be varying according to the occupied room category. Before admission kindly chooses the
bed category,
 Packaged bill may vary due to clinical complication, high value medications, consumables and extension of
hospitalization as advised by treating doctors.
 Patient if have any health insurance policy, to be infirmed and submit the details at the time of admission with
followed by Health card, Emp id Prof, Govt ID Proof and relevant diagnostic reports. in case of emergency
admission insurance documents need to be submitted within 24 hrs. Payments done toward Non medical
expenses, co-payments, denial of insurance and if any restriction on policy at the time of discharge. In case
denial of cashless facilities from the Insurance company Hospital/Hospital staff will not be responsible for
same.
 Above 2 lakhs cash transaction are restricted as per Govt Financial rules under section 269ST per patient
bill/Admission bill.

I Mr./Mrs./Ms__________________________ Companion of the patient________________________ have agreed the estimated

charges and would settle the bill according to the terms and condition of the hospital before the discharge.

Relationship with Patient: Billing Executive/Counsellor Sign:

Contact No:
Patient/ Attendant Sign: