Permission for Uncoded Procedure/ Investigation/ Implants from the Office of the Additional Director
Documents required are:
- Request letter to give permission, from card holder clearly mentioning the name of the uncoded procedure/investigation/implants and the name of the empanelled hospital where he intends to avail treatment.
- Govt specialist advise clearly mentioning said procedure/investigation or implant. Vague advice like advised surgery without mentioning the actual procedure is not acceptable.
- One estimate from empanelled hospital where patient intends to take treatment. In case of uncoded implants three estimates /quotations are must.
- Other relevant medical documents in support of beneficiary illness.
- CGHS card copy (of beneficiary and card holder).
- Permission shall be given based on the lowest quote available (Additional Director office has few quotations submitted by other hospitals) to undergo said treatment in requested empanelled hospital. Three copies of Permission are issued (one Wellness Centre copy, one beneficiary copy and one empanelled hospital copy).
- In the case of uncoded procedures/investigations in non-empanelled hospitals, the powers are vested with AS&DG. The powers of Additional director are up to 1 lakh, beyond which, the request is forwarded to ministry.
- No permission can be given in emergency by relaxing any requisite documents. If it is emergency, empanelled hospital is supposed to go ahead with such treatment or procedures and submit the claim to UTI.
- Once the permission is issued, the referral letter is to be obtained from respective Wellness Centre.
- Empanelled hospitals are bound to accept these patients and charge at the rate specified or their rate, whichever is lower. They are to enclose invoice for the implant along with permission letter of AD (which has mention of rate to be reimbursed-the referral letter issued at wellness centre routinely does not have mention of rate) while submitting claim to UTI ITSL.
In case of serving employees, the permission shall be obtained from their parent department.