Ministry issues guidelines to ensure fair treatment to CGHS beneficiaries

The Health Ministry has noted multiple complaints about CGHS beneficiaries being overcharged or denied treatment by certain CGHS-empanelled hospitals. In response, the ministry has issued guidelines mandating strict adherence to established instructions by these healthcare organisations.

 

Key highlights of the new guidelines:

 

Consistency in care: Empanelled hospitals are now required to follow standardised treatment protocols for common procedures and ailments. This ensures that no matter which hospital a beneficiary visits, they can expect the same high standard of care.

 

Clearer costs: Hospitals must now display CGHS-approved rates for their services. This means beneficiaries can see what they’ll be charged upfront, avoiding any surprises.

 

 

Checks on high-cost treatments: For certain expensive procedures, hospitals will need to get the green light from CGHS before going ahead. This step helps ensure that beneficiaries are not pushed into unnecessary treatments.

 

Transparency in treatment denials: If a hospital denies treatment to a CGHS beneficiary, they have to report it and explain why. This measure brings in a new level of accountability, making sure beneficiaries are treated fairly.

 

Strict compliance measures: Hospitals that do not follow these guidelines could face penalties, including being removed from the CGHS network. This keeps all hospitals on their toes, ensuring they stick to the rules.

 

“In cases of patient death or when the patient is in a coma, the signatures of the beneficiaries’ attendants, along with their mobile numbers, must be obtained on the final bills for all indoor and OPD services, including daycare, laboratory services, dialysis, etc,” the ministry said.

 

Hospitals have been instructed to provide details of non-referral cases, emergency admissions, and consultations to the respective additional director's office of CGHS via email within 24 hours.

 

“These measures directly benefit CGHS beneficiaries by ensuring transparency, affordability, and accountability. Beneficiaries can now expect timely medical attention without fear of denial or unexpected financial burdens. By standardising practices like reporting emergency admissions and banning brand-specific prescriptions, the ministry safeguards patients' rights and reinforces trust in the healthcare system. As a result, the advisory not only enforces discipline among hospitals but also strengthens the foundation of equitable healthcare in India,” said Biplab Lenin, partner, Cyril Amarchand Mangaldas.

 

Pankaj Nawani, CEO, CarePal Secure explains what this guideline means for CGHS beneficiaries:

 

Better access to quality care: No more wondering if you’re getting the same quality of care as someone else. These standardised protocols mean everyone gets the best possible treatment, wherever they are.

 

Cost clarity: With rates on display, beneficiaries can plan their finances better and avoid those dreaded unexpected charges. It is a big step towards making healthcare expenses more predictable.

 

Protection against overcharges: The pre-approval process for costly procedures protects beneficiaries from unnecessary or overpriced treatments. It’s a safeguard to ensure you’re only paying for what you truly need.

 

Fair treatment guaranteed: The requirement for hospitals to report any denial of treatment means beneficiaries have a layer of protection. If something goes wrong, there’s a clear system in place to address it.

 

Enhanced trust and quality assurance: With penalties for non-compliance, hospitals are incentivised to deliver top-notch care. This builds trust in the system and reassures beneficiaries that they’re in good hands.