After son's death, man struggles to get refund from hospital
Daily wage-earner Mohammed Yunus Warunkar is an angry man. After losing his son to a rare disease Guillain–Barré Syndrome (GBS) in September, he is still waiting to be reimbursed for Rs 48,000 that he had shelled out under the Rajiv Gandhi Jeevandayi Arogya Yojana (RGJAY). To make matters worse, he has to bear the brunt of his neighbours and friends from whom he had taken the loan.
There are various reasons why the state government hasn’t given him the money yet. First, the chemist shop from where Warunkar bought the injections for his son Muzammil’s treatment didn’t have a vendor’s account with the Brihanmumbai Municipal Corporation. Later, the Arogya Mitras at Sion Hospital, where his son was admitted, didn’t possess a stamp to certify the medical bills.
Eight year-old Muzammil was admitted to Sion Hospital in September as he was suffering from GBS. Warunkar, who works for a daily wage of Rs 100, had to buy six injections of Rs 8,000 each for his child’s treatment. After he expressed his inability to purchase the injections, doctors advised him to enroll under the yojana. On the same day he applied for the health scheme and submitted the required documents.
Then under the assurances of the Arogya Mitras of the hospital, that he would be reimbursed, he borrowed money from his neighbours and friends. But even after submitting the required documents, Warunkar is forced to frequently visit the Arogya Mitras to get the sanctioned refund. The reason for the delay is the new clauses put forward by the Municipal Corporation of Greater Mumbai (MCGM) on a daily basis.
Warunkar said, “I hardly earn Rs 3,000 a month and was not in a position to bear the medical expenses for my son’s treatment. I already had my Aadhaar card and ration card, which I submitted with other necessary documents to the Arogya Mitras. They confirmed that all the papers were in place and my file would be forwarded for approval. However, I am yet to receive the amount.”
Since the required injections were not available at Sion Hospital, he had to purchase them from a pharmacy in Dadar. He spent Rs 48,000 that were meant for three days of treatment. However, on the fourth day Muzammil started facing respiratory complications and he was immediately put on a ventilator. On September 24 around 8.15 pm he succumbed to his ailment.
The start of a problem
In October the Arogya Mitras informed Warunkar that the pharmacy from where he had purchased the injections did not have a vendor’s account with the BMC. Unless a vendor account is opened the money could not be reimbursed. Warunkar requested the pharmacy owner and a vendor account was opened and the related documents were submitted to the Arogya Mitras on October 17. The Arogya Mitras then assured Warunkar that he would receive the money within the next 15 days. However, when he went to the hospital to inquire about the status on December 15, he was given another excuse for further delay.
No stamp, no money
This time he was told that the file is still pending with the accounts department as the formality of a verification stamp is still pending. It is only after this stamp is put on the bills verifying that the mentioned expenses are genuine that the file can be forwarded to the head office. The Yojana staff at the hospital says that they have placed an order for the stamp to be made and until then the file cannot be forwarded.
Yojana staff speaks
Ganesh Waghmare, one of the Arogya Mitras at Sion hospital said, “All the documents submitted by Warunkar are as per the requirements. There is nothing pending from his side, instead the delay is from our end. We receive new instructions and clauses from the MCGM which has led to the confusion and delay.” He added, “We have forwarded the file to the accounts department for clearance but they do not have the verification stamp. We have placed an order for the same a couple of days ago and are waiting for the stamp to arrive.” Waghmare confirmed that the medical expenses for Warunkar’s son were sanctioned as early as September.
Yojana CEO, K Venkatesan said, “Usually such delays do not occur from our side. This seems to be an unusual case. I will look into the matter and do the needful for quick processing of the file.” However, he refused to comment on the number of days within which the reimbursement is provided to a patient or a hospital.
What is GBS?
Muzammil was brought to Sion Hospital on September 21 after he was unable to write or do any work with his hands. His fingers clawed on both his hands rendering them weak due to which he could not even eat his food. The doctors immediately admitted him to the Pediatric Intensive Care Unit. They diagnosed the problem to be GBS, a disorder affecting the peripheral nervous system. Doctors informed Warunkar that a special injection has to be administered to the patient twice a day. If he would not continue the treatment his son could suffer from paralysis.
What is RGJAY?
In July this year, the state government launched Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in order to improve medical access facility for both Below Poverty Line (BPL — Yellow card holders) and Above Poverty Line (APL — orange card holders) families.
RGJAY would be implemented throughout Maharashtra in a phased manner for a period of three years. Only families holding yellow ration cards, Antyodaya Anna Yojana card (AAY), Annapurna card and orange ration are eligible for the yojana. The scheme is available in eight districts: Gadchiroli, Amravati, Nanded, Sholapur, Dhule, Raigad, Mumbai and suburbs. Families with white ration cards would not be covered under the scheme.