Ayushman Yojana के तहत क्लेम भुगतान के नियमों में बदलाव, दो अक्टूबर से लागू होगी नई व्यवस्था
आयुष्मान योजना में मरीज को मिलने वाले निश्शुल्क उपचार के सत्यापन के बाद ही संबंधित अस्पताल को क्लेम का भुगतान होगा। राज्य स्वास्थ्य प्राधिकरण ने यह निर्णय लिया है।
आयुष्मान योजना को राज्य में संचालित हुए चार साल पूरे हो गए हैं। इस अवधि में पांच लाख 75 हजार से अधिक बार मरीजों का उपचार किया गया है। पर कुछ लाभार्थियों ने समय-समय पर यह शिकायत की कि योजना में सूचीबद्ध चिकित्सालयों ने उन्हें पूरी तरह निश्शुल्क उपचार का लाभ नहीं दिया गया और उनसे धनराशि ली गई।
जो कि आयुष्मान योजना की गाइडलाइन व चिकित्सालय के साथ हुए अनुबंध के विरुद्ध है। ऐसे कई मामलों में प्राधिकरण ने संबंधित लाभार्थियों से ली गई धनराशि को चिकित्सालय से वापस भी कराया।
मरीज से लिया जाएगा सत्यापन प्रमाण पत्र:
पिछले दिनों आरोग्य मंथन में शिरकत करने के दौरान स्वास्थ्य मंत्री डा. धन सिंह रावत ने भी आयुष्मान योजना के प्रभावी क्रियान्वयन के लिए ठोस कदम उठाने के निर्देश विभागीय अधिकारियों को दिए थे। जिसमें कहा गया था कि दो अक्टूबर से मरीज से सत्यापन प्रमाण पत्र (इलाज पर आए खर्च के बिलों पर हस्ताक्षर) लेने के बाद ही अस्पतालों को क्लेम का भुगतान किया जाए।
इसके बाद प्राधिकरण ने इस संदर्भ में सभी सूचीबद्ध अस्पतालों को निर्देश जारी किए हैं। जिसमें कहा गया है कि चिकित्सालयों का लाभार्थी के उपचारोपरांत क्लेम प्रस्तुत करते समय लाभार्थी का सत्यापन प्रपत्र व चिकित्सालय का प्रमाण-पत्र दाखिल किया जाना अनिवार्य है। ये सभी नई व्यवस्थाएं दो अक्टूबर से लागू होंगी।
लाभार्थी यह करेगा सत्यापित:
चिकित्सालय ने योजना के अंतर्गत निश्शुल्क उपचार किया है।
उपचार की एवज में उनसे कोई धनराशि नहीं ली गई। बाहर से कोई दवा अथवा उपचार संबंधी अन्य सामान नहीं मंगवाया गया।
उपचार से संबंधित सभी दस्तावेज यानी डिस्चार्ज समरी, जांच रिपोर्ट, उपचार का बिल आदि चिकित्सालय ने उपलब्ध करा दिए हैं।
लाभार्थी प्रमाणित करेगा कि प्रपत्र उसने या परिवार के सदस्य ने भरा है, चिकित्सालय के किसी स्टाफ ने नहीं।
चिकित्सालय देगा यह प्रमाण-पत्र
योजना के अंतर्गत मरीज का पूरी तरह निश्शुल्क इलाज किया गया है।
उपचार से संबंधित सभी दस्तावेज मरीज को उपलब्ध करा दिए हैं।
डिस्चार्ज के बाद मरीज को आवश्यकतानुसार 15 दिन की अवधि की दवा निश्शुल्क उपलब्ध करा दी है।
उपचार पर कितना खर्च आया और अब पांच लाख के वालेट में कितनी धनराशि शेष है।
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