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ESIC Patient Forced to Pay Rs 4.30 Lakh Despite Cashless Treatment Eligibility
A shocking incident in Mohali has exposed gaps in India’s healthcare welfare system after an Employees’ State Insurance Corporation (ESIC) patient was denied cashless treatment. The patient, a factory worker, was charged Rs 4.30 lakh for emergency cardiac procedures—despite being entitled to coverage under the ESIC scheme. The case has triggered outrage, prompting calls for stricter enforcement of medical benefits.
Hospital Refuses Cashless Treatment, Cites “Technical Issues”
The 45-year-old patient was admitted to an ESIC-empaneled hospital following a cardiac emergency. Despite presenting a valid ESIC card, the hospital allegedly refused cashless treatment, claiming “technical glitches” with the ESIC portal.
With no alternative, the family borrowed Rs 4.30 lakh to cover angioplasty and hospitalization costs. “We were pressured to pay upfront, only to later learn the hospital should have treated first and claimed reimbursement later,” said the patient’s son.
ESIC’s Inquiry: Who’s Responsible?
ESIC officials confirmed the hospital was authorized for cashless treatment and have launched an investigation. However, they have yet to guarantee reimbursement for the family. Meanwhile, the hospital denies wrongdoing, blaming “system failures.”
Insiders suggest delayed ESIC reimbursements to hospitals may be discouraging cashless services—a recurring issue affecting beneficiaries nationwide.
Growing Concerns Over ESIC Scheme Implementation
This incident highlights systemic flaws in India’s healthcare schemes, where policy intent often clashes with ground realities. The ESIC scheme, covering 13 crore employees and dependents, faces criticism for delayed payments and lax oversight.
Healthcare activists demand accountability: “Hospitals must not deny rightful treatment. ESIC must penalize violations and expedite payments,” said an advocate.
Next Steps: Will Justice Prevail?
The family has filed complaints with ESIC and Punjab’s health department, seeking refunds and action against the hospital. Workers’ unions and politicians are amplifying calls for reform.
As investigations unfold, this case underscores the urgent need to streamline ESIC processes—ensuring no patient faces financial distress during emergencies.
Key Takeaways:
- Cashless Treatment Denied: ESIC patient billed Rs 4.30 lakh despite coverage.
- Hospital Under Scrutiny: Empaneled facility blamed “technical issues”; ESIC alleges protocol breach.
- Systemic Delays: Hospitals may be refusing cashless services over pending ESIC dues.
- Public Backlash: Demands for reimbursement and stricter enforcement grow.
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