ANNEXURE II: LIST OF EXPENSES EXCLUDED (“NON-MEDICAL”) | ||
SNO | LIST OF EXPENSES EXCLUDED (“NON-MEDICAL”) | SUGGESTIONS |
TOILETRIES/COSMETICS/ PERSONAL COMFORT OR CONVENIENCE ITEMS | ||
1 | HAIR REMOVAL CREAM | Not Payable |
2 | BABY CHARGES (UNLESS SPECIFIED/INDICATED) | Not Payable |
3 | BABY FOOD | Not Payable |
4 | BABY UTILITES CHARGES | Not Payable |
5 | BABY SET | Not Payable |
6 | BABY BOTTLES | Not Payable |
7 | BRUSH | Not Payable |
8 | COSY TOWEL | Not Payable |
9 | HAND WASH | Not Payable |
10 | M01STUR1SER PASTE BRUSH | Not Payable |
11 | POWDER | Not Payable |
12 | RAZOR | Payable |
13 | SHOE COVER | Not Payable |
14 | BEAUTY SERVICES | Not Payable |
15 | BELTS/ BRACES | Essential and may be paid specifically for cases
who have undergone surgery of thoracic or lumbar spine. |
16 | BUDS | Not Payable |
17 | BARBER CHARGES | Not Payable |
18 | CAPS | Not Payable |
19 | COLD PACK/HOT PACK | Not Payable |
20 | CARRY BAGS | Not Payable |
21 | CRADLE CHARGES | Not Payable |
22 | COMB | Not Payable |
23 | DISPOSABLES RAZORS CHARGES ( for site preparations) | Payable |
24 | EAU-DE-COLOGNE / ROOM FRESHNERS | Not Payable |
25 | EYE PAD | Not Payable |
26 | EYE SHEILD | Not Payable |
27 | EMAIL / INTERNET CHARGES | Not Payable |
28 | FOOD CHARGES (OTHER THAN PATIENT’S DIET PROVIDED BY
HOSPITAL) |
Not Payable |
29 | FOOT COVER | Not Payable |
30 | GOWN | Not Payable |
31 | LEGGINGS | Essential in bariatric and varicose vein surgery and
should be considered for these conditions where surgery itself is payable. |
32 | LAUNDRY CHARGES | Not Payable |
33 | MINERAL WATER | Not Payable |
34 | OIL CHARGES | Not Payable |
35 | SANITARY PAD | Not Payable |
36 | SLIPPERS | Not Payable |
37 | TELEPHONE CHARGES | Not Payable |
38 | TISSUE PAPER | Not Payable |
39 | TOOTH PASTE | Not Pavable |
40 | TOOTH BRUSH | Not Payable |
41 | GUEST SERVICES | Not Payable |
42 | BED PAN | Not Payable |
43 | BED UNDER PAD CHARGES | Not Payable |
44 | CAMERA COVER | Not Payable |
45 | CLINIPLAST | Not Payable |
46 | CREPE BANDAGE | Not Payable/ Payable by the patient |
47 | CURAPORE | Not Payable |
48 | DIAPER OF ANY TYPE | Not Payable |
49 | DVD, CD CHARGES | Not Payable ( However if CD is specifically sought
by In surer/TPA then payable) |
50 | EYELET COLLAR | Not Payable |
51 | FACE MASK | Not Payable |
52 | FLEXI MASK | Not Payable |
53 | GAUSE SOFT | Not Payable |
54 | GAUZE | Not Payable |
55 | HAND HOLDER | Not Payable |
56 | HANSAPLAST/ADHESIVE BANDAGES | Not Payable |
57 | INFANT FOOD | Not Payable |
58 | SLINGS | Reasonable costs for one sling in case of upper
arm fractures should be considered |
ITEMS SPECIFICALLY EXCLUDED IN THE POLICIES | ||
59 | WEIGHT CONTROL PROGRAMS/ SUPPLIES/ SERVICES | Not Payable |
60 | COST OF SPECTACLES/ CONTACT LENSES/ HEARING AIDS
ETC., |
Not Payable |
61 | DENTAL TREATMENT EXPENSES THAT DO NOT REQUIRE
HOSPITALISATION |
Not Payable |
62 | HORMONE REPLACEMENT THERAPY | Not Payable |
63 | HOME VISIT CHARGES | Not Payable |
64 | INFERTILITY/ SUBFERTILITY/ ASSISTED CONCEPTION
PROCEDURE |
Not Payable |
65 | OBESITY (INCLUDING MORBID OBESITY) TREATMENT IF
EXCLUDED IN POLICY |
Not Payable |
66 | PSYCHIATRIC & PSYCHOSOMATIC DISORDERS | Not Payable |
67 | CORRECTIVE SURGERY FOR REFRACTIVE ERROR | Not Payable |
68 | TREATMENT OF SEXUALLY TRANSMITTED DISEASES | Not Payable |
69 | DONOR SCREENING CHARGES | Not Payable |
70 | ADMISSION/REGISTRATION CHARGES | Not Payable |
71 | HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE | Not Payable |
72 | EXPENSES FOR INVESTIGATION/ TREATMENT IRRELEVANT TO THE DISEASE FOR WHICH ADMITTED OR DIAGNOSED | Not Payable |
73 | ANY EXPENSES WHEN THE PATIENT IS DIAGNOSED WITH
RETRO VIRUS + OR SUFFERING FROM /HIV/ AIDS ETC IS DETECTED/ DIRECTLY OR INDIRECTLY |
Not Payable |
74 | STEM CELL IMPLANTATION/ SURGERY and storage | Not Payable |
ITEMS WHICH FORM PART OF HOSPITAL SERVICES WHERE SEPARATE CONSUMABLES ARE NOT PAYABLE BUT THE | ||
75 | WARD AND THEATRE BOOKING CHARGES | Payable under OT Charges, not separately |
76 | ARTHROSCOPY & ENDOSCOPY INSTRUMENTS | Rental charged by the Hospital payable. Purchase
of Instruments Not Payable. |
77 | MICROSCOPE COVER | Payable under OT Charges, not separately |
78 | SURGICAL BLADES, HARMONIC SCALPEL, SHAVER | Payable under OT Charges, not separately |
79 | SURGICAL DRILL | Payable under OT Charges, not separately |
80 | EYE KIT | Payable under OT Charges, not separately |
81 | EYE DRAPE | Payable under OT Charges, not separately |
82 | X-RAY FILM | Payable under Radiology Charges, not as
consumable |
83 | SPUTUM CUP | Payable under Investigation Charges, not as
consumable |
84 | BOYLES APPARATUS CHARGES | Part of OT Charges, not separately |
85 | BLOOD GROUPING AND CROSS MATCHING OF DONORS
SAMPLES |
Part of Cost of Blood, not payable |
86 | Antiseptic or disinfectant lotions | Not Payable – Part of Dressing Charges |
87 | BAND AIDS, BANDAGES, STERLILE INJECTIONS, NEEDLES,
SYRINGES |
Not Payable – Part of Dressing charges |
88 | COTTON | Not Payable -Part of Dressing Charges |
89 | COTTON BANDAGE | Not Payable- Part of Dressing Charges |
90 | MICROPORE/ SURGICAL TAPE | Not Payable – Part of Dressing Charges |
91 | BLADE | Not Payable |
92 | APRON | Not Payable |
93 | TORNIQUET | Not Payable |
94 | ORTHOBUNDLE, GYNAEC BUNDLE | Not Payable, Part of Dressing Charges |
95 | URINE CONTAINER | Not Payable |
ELEMENTS OF ROOM CHARGE | ||
96 | LUXURY TAX | Actual tax levied by government is payable. Part of
room charge for sub limits |
97 | HVAC | Part of room charge, Not Payable separately |
98 | HOUSE KEEPING CHARGES | Part of room charge, Not Payable separately |
99 | SERVICE CHARGES WHERE NURSING CHARGE ALSO
CHARGED |
Part of room charge, Not Payable separately |
100 | TELEVISION & AIR CONDITIONER CHARGES | Part of room charge, Not Payable separately |
101 | SURCHARGES | Part of room charge, Not Payable separately |
102 | ATTENDANT CHARGES | Part of room charge, Not Payable separately |
103 | IM IV INJECTION CHARGES | Part of nursing charge, Not Payable separately |
104 | CLEAN SHEET | Part of Laundry / Housekeeping, Not Payable
separately |
105 | EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS
PART OF BED CHARGE) |
Patient Diet provided by Hospital is payable |
106 | BLANKET/WARMER BLANKET | Part of room charge, Not Payable separately |
ADMINISTRATIVE OR NON – MEDICAL CHARGES | ||
107 | ADMISSION KIT | Not Payable |
108 | BIRTH CERTIFICATE | Not Payable |
109 | BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING
CHARGES |
Not Payable |
110 | CERTIFICATE CHARGES | Not Payable |
111 | COURIER CHARGES | Not Payable |
112 | CONVENYANCE CHARGES | Not Payable |
113 | DIABETIC CHART CHARGES | Not Payable |
114 | DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES | Not Payable |
115 | DISCHARGE PROCEDURE CHARGES | Not Payable |
116 | DAILY CHART CHARGES | Not Payable |
117 | ENTRANCE PASS / VISITORS PASS CHARGES | Not Payable |
118 | EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE | Payable under Post- Hospitalisation where
admissible |
119 | FILE OPENING CHARGES | Not Payable |
120 | INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED) | Not Payable |
121 | MEDICAL CERTIFICATE | Not Payable |
122 | MAINTENANCE CHARGES | Not Payable |
123 | MEDICAL RECORDS | Not Payable |
124 | PREPARATION CHARGES | Not Payable |
125 | PHOTOCOPIES CHARGES | Not Payable |
126 | PATIENT IDENTIFICATION BAND / NAME TAG | Not Payable |
127 | WASHING CHARGES | Not Payable |
128 | MEDICINE BOX | Not Payable |
129 | MORTUARY CHARGES | Payable up to 24 hrs, shiGing charges not payable |
130 | MEDICO LEGAL CASE CHARGES (MLC CHARGES) | Not Payable |
EXTERNAL DURABLE DEVICES | ||
131 | WALKING AIDS CHARGES | Not Payable |
132 | BIPAP MACHINE | Not Payable |
133 | COMMODE | Not Payable |
134 | CPAP/ CAPD EQUIPMENTS | Device not payable |
135 | INFUSION PUMP – COST | Device not payable |
136 | OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL) | Not Payable |
137 | PULSEOXYMETER CHARGES | Device not payable |
138 | SPACER | Not Payable |
139 | SPIROMETRE | Device not payable |
140 | SP02 PROBE | Not Payable |
141 | NEBULIZER KIT | Not Payable |
142 | STEAM INHALER | Not Payable |
143 | ARMSLING | Not Payable |
144 | THERMOMETER | Not Payable |
145 | CERVICAL COLLAR | Not Payable |
146 | SPLINT | Not Payable |
147 | DIABETIC FOOT WEAR | Not Payable |
148 | KNEE BRACES ( LONG/ SHORT/ HINGED) | Not Payable |
149 | KNEE IMMOBILIZER/SHOULDER IMMOBILIZER | Not Payable |
150 | LUMBOSACRAL BELT | Payable for surgery of lumbar spine. |
151 |
NIMBUS BED OR WATER OR AIR BED CHARGES |
Payable for any ICU patient requiring more than 3 days in ICU, all patients with paraplegia
/quadriplegia for any reason and at reasonable cost of approximately Rs 200/day |
152 | AMBULANCE COLLAR | Not Payable |
153 | AMBULANCE EQUIPMENT | Not Payable |
154 | MICROSHEILD | Not Payable |
155 |
ABDOMINAL BINDER |
Essential and should be paid in post-surgery patients of major abdominal surgery including TAH, LSCS, incisional hernia repair, exploratory laparotomy for intestinal obstruction, liver
transplant etc. |
ITEMS PAYABLE IF SUPPORTED BY A PRESCRIPTION | ||
156 | BETADINE / HYDROGEN PEROXIDE / SPIRIT / DISINFECTANTS
ETC |
Not Payable |
157 | PRIVATE NURSES CHARGES – SPECIAL NURSING CHARGES
Post hospitalization nursing charges |
Not Payable |
158 |
NUTRITION PLANNING CHARGES – DIETICIAN
CHARGESDIET CHARGES |
Patient Diet provided by hospital is payable |
159 | SUGAR FREE Tablets | Payable -Sugar free variants of admissible
medicines are not excluded |
160 | CREAMS POWDERS LOTIONS | Payable when prescribed (Toiletries are not
payable, only prescribed medical pharmaceuticals payable) |
161 | Digestion gels | Payable when prescribed |
162 | ECG ELECTRODES | One set every second day is Payable. |
163 | GLOVES Sterilized | Gloves payable / unsterilized gloves not payable |
164 | HIV KIT | payable Pre-operative screening |
165 | LISTERINE/ ANTISEPTIC MOUTHWASH | Payable when prescribed |
166 | LOZENGES | Payable when prescribed |
167 | MOUTH PAINT | Payable when prescribed |
168 | NEBULISATION KIT | If used during Hospitalisation is Payable
reasonably |
169 | NOVARAPID | Payable when prescribed |
170 | VOLINI GEL/ ANALGESIC GEL | Payable when prescribed |
171 | ZYTEE GEL | Payable when prescribed |
172 | VACCINATION CHARGES | Routine Vaccination not Payable / Post Bite
Vaccination Payable |
PART OF HOSPITAL’S OWN COSTS AND NOT PAYABLE | ||
173 | AHD | Not Payable – Part of Hospital’s internal Cost |
174 | ALCOHOL SWABES | Not Payable – Part of Hospital’s internal Cost |
175 | SCRUB SOLUTION/STERILLIUM | Not Payable – Part of Hospital’s internal Cost |
OTHERS | ||
176 | VACCINE CHARGES FOR BABY | Not Payable |
177 | AESTHETIC TREATMENT / SURGERY | Not Payable |
178 | TPA CHARGES | Not Payable |
179 | VISCO BELT CHARGES | Not Payable |
180 | ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT,
ORTHOKIT, RECOVERY KIT, ETC] |
Not Payable |
181 | EXAMINATION GLOVES | Not payable |
182 | KIDNEY TRAY | Not Payable |
183 | MASK | Not Payable |
184 | OUNCE GLASS | Not Payable |
185 | OUTSTATION CONSULTANT’S/ SURGEON’S FEES | Not payable |
186 | OXYGEN MASK | Not Payable |
187 | PAPER GLOVES | Not Payable |
188 | PELVIC TRACTION BELT | Payable in case of PIVD requiring traction |
189 | REFERAL DOCTOR’S FEES | Not Payable |
190 | ACCU CHECK (Glucometery/ Strips) | Not payable pre Hospitalisation or post
Hospitalisation / Reports and Charts required / Device not payable |
191 | PAN CAN | Not Payable |
192 | SOFNET | Not Payable |
193 | TROLLY COVER | Not Payable |
194 | UROMETER, URINE JUG | Not Payable |
195 | AMBULANCE | Payable |
196 | TEGADERM / VASOFIX SAFETY | Payable – maximum of 3 in 48 hrs and then 1 in 24
hrs |
197 | URINE BAG | Payable where Medically Necessary – maximum 1
per 24 hrs |
198 | SOFTOVAC | Not Payable |
199 | STOCKINGS | Payable for case like CABG etc. |
deep vein thrombosis charges payable?
Yes, deep vein thrombosis is payable.
Patient food charges are payable ?
Addtional Food Charges are not payable. If its internal part of room rent, then its payable