Government employee alleges hospital withheld CMHIS package limits

Morung Express News 
Dimapur | July 7

A state government employee has alleged that an empanelled private hospital failed to disclose limits on medical packages covered under the Chief Minister’s Health Insurance Scheme (CMHIS) for government employees, leaving his family with an outstanding bill of over Rs 5.15 lakh.

The employee, whose identity is withheld for confidentiality reasons, alleged that the hospital management assured him his CMHIS-EP card was functional but kept him in the dark regarding coverage limits for neonatal care.

According to the employee, his pregnant wife was admitted to Eden Medical Center on April 12, where she underwent a Caesarean section. Following the birth, the newborn was transferred to the Neonatal Intensive Care Unit (NICU) on April 16 due to health complications.

While the mother was later discharged, the infant remained in the intensive care unit for approximately two months. During the mother's discharge, the hospital billed her Rs 48,000, of which the CMHIS card covered Rs 34,000. The employee paid the remaining Rs 14,000 balance in cash.

On June 19, the hospital referred the infant to another medical facility. The bill for the stay in NICU amounted to Rs 6,79,679. To his surprise, he said that CMHIS-EP covered only Rs 1,63,975, requiring him to pay an outstanding balance of Rs 5,15,704.

According to him, he was under the impression that the state insurance scheme would cover 70-80 percent of the NICU charges as told to him by the hospital attendants during the stay. When he further made inquiries, hospital staff reportedly told him that package structures for infants differ from adult packages and do not cover all intensive care procedures. 

He claimed that it contradicted what he was told by attendants at the billing department during the hospital stay. According to him, he regularly inquired from the billing department about costs, to which the staff allegedly only provided verbal updates on the bill status, and did not clarify that the insurance coverage was capped.

He questioned the sudden charge, and alleged lack of transparency and information regarding the various medical packages covered by the CMHIS-EP. 

“What can a poor person like me say? We are in distress,” the employee said, adding that he has two other children to support. “If it is a government scheme, if it does not help poor people, then what is the use?”

Following the referral, the infant was admitted to the NICU of a second empanelled hospital, where reportedly he was assured that the CMHIS scheme would cover the treatment costs.

Regarding the pending Rs 5,15,704 bill, he requested the first hospital for additional time to secure a loan to clear it. 

He added, “We contributed Rs 400 every month with the trust that this CMHIS-EP card would help us in times of need. But now it feels like we are not getting any help.” 

The Eden Medical Center management said that it will be issuing a statement in connection to the allegation.