मराठी | English
Frequently Asked Questions for Haemodialysis :
1)Who is eligible for receiving Maintenance Haemodialysis treatment under MJPJAY?
2)Which services are provided under package of Maintenance Haemodialysis under MJPJAY for the patient?
3)Does patient have to pay any extra money for treatment?
4)What should be frequency of dialysis cycles under MJPJAY for each approved preauth?
5)If patient requires blood transfusion, is cost of blood transfusion covered under package?
6)Will Balance Sum Insured used for dialysis patient limit other household members to avail services under MJPJAY?
7)Is AV fistula covered under Maintenance Haemodialysis package?
8)Can HIV or HCV positive cases avail Maintenance Haemodialysis service under MJPJAY ?
9)If a patient has consumed certain amount from sum assured for Haemodialysis cycles and later on he/she requires renal transplant how much amount will be approved for this patient.
10)In case of a query or to register a complaint what should I do ?
Frequently Asked Questions :
1) Who has prepared the MOU?
2) Is Dietary Services Compulsory?
3) Can the approval be not pre planned?
4) If the system is package system, why is billing to be generated?
5) What if the bill is more?
6) Is Deposits are required by hospitals?
7) Will deposit be refunded after getting payment from MDIndia?
8) Are the rates, inclusive of taxes or exclusive?
9) What if hospital is ready to give scanner, PC, and Desk?
10) Is there any specific size for Aarogyamitra Kiosk?
11) Why is Investigation irrespective of surgeries required to be free?
12) Will beneficiaries visit only for surgeries?
13) What is the Medical/Surgical or 121 follow up procedures?
14) What happens to hospitals which do not have ICU, especially Govt?
15) If on table, additional ailment is detected how to proceed for additional approval? ( e.g. Umbilical hernia, and then appendicitis is detected?
16) Is LOS (Length of Stay) defined?
17) Why is there is huge documentation and 3 photographs required?
18) Why details of already filled information are online are asked again in MOU?
19) Are complications covered?
20) If enhancement is allowed in cases of complications what will be the grounds of giving the enhancement by Society or will it be payable as per actual charges of hospital?
21) Is conducting 1 camp per week compulsory?
22) Will Medico Legal cases be covered?
23) Conducting health camps will be a big issue as Doctors are not comfortable. What if they do not conduct due to various reasons (Shortage of doctors, not taking equipment's to camp, provide free medications)?
24) As per MOU the hospital needs to take equipment's like USG, 2d Echo which is practically not possible. Is this mandatory if hospital ties up?
25) OT operative photo is required. How can the surgeon or consultant do it?
26) In case there are more than 5-10 patients coming, the MCO will be not able to take so many photos. Can the Arogyamitratake the photos?
27) How much amount to be given out of package to consultants?
28) Cost of implant is sometimes higher than package?
29) Is there any waiting prior or preexisting exclusion?
30) Are glasses covered in cataract surgery?
31) What about history manipulation?
32) Is Hernia covered?
33) Is Appendicitis covered?
34) If case of appendicitis comes as emergency in private hospital whether the hospital can admit the patient? If yes what will be the package applicable?
35) Angiography is sometimes done without indications
36) What will the TAT for Pre Authorization?
37) Pre authorization TAT is very high?
38) Who will bear the Ambulance charges?
39) Is the MJPJAY only for General Ward? Some hospitals have very less Gen Wards. Can the patient not be treated in higher category?
40) In case of transportation for absence of beds, who will transfer and be responsible for the same?
41) In case of complications and transfer required, then who is responsible for the charges?
42) The poor patient will not be able to bear the charges of the cardiac ambulance. Then what happens?
43) In case the patient is first authorized for Acute MI management and then during CAG requires PTCA, then will both the package charges be paid in full or CAG/2D Echo/ECG charges deducted as it is overlapping in both procedures?
44) In a package it is envisaged that the blood and platelets are to be transfused. But quantity is not mentioned?
45) We already are overloaded and cannot give preference to the beneficiary families. They will have to move through the regular registration and consultation system?
46) In case the total treatment cost exceeds the limit of Rs 1.5 lakhs whether hospital can collect the exceeding amount from patient?
47) If treatment is started for the patient and hospital receives denial from society who will bear the cost of treatment given till that time?
48) Patient comes to the hospital in emergency for ailment which is not covered in the package list, whether hospital can deny / charge as per actuals to the patient?
49) In cancer cases the treatment protocols have been defined. However if the treating consultant prefers another treatment protocol for the same diagnosis whether the case will be paid? If yes - what will be the package?
50) As per the MOU the hospital is to reserve 25% of the beds for MJPJAY. Does this mean the 25% of overall bed capacity of hospital or 25% of general ward beds?
51) Whether the packages will be same for three years or going to be revised every year?
52) If hospital upgrades the infrastructure and the facilities whether the rate list will be upgraded. If yes will revision be applicable with immediate effect?
53) In medical / critical cases what is the base to apply for the enhancement as the length of stay is not mentioned in packages. So it will be difficult if the treatment envisages longer duration of stay and medicine expenses go beyond the package rates?
54) If patient voluntarily opts for higher cost implant whether hospital can collect the cost of implant from the patient?