Process Flow

Process Flow

Process Flow of the Beneficiary Treatment in the Network Hospital

Step 1:

Beneficiaries approach nearby PHC/Area Hospitals/District Hospital/Network Hospital. Aarogya Mithras placed in the above hospitals facilitate the beneficiary.If beneficiary visits any other PHC/Government hospital other than the Network Hospital, he/she will be given a referral card to the Network Hospital after preliminary diagnosis by the doctors. The Beneficiary may also attend the Health Camps being conducted by the Network Hospital in the Villages and can get the referral card based on the diagnosis

Step 2:

The Aarogya mithras at the Network Hospital examines the referral card and BPL ration card and facilitates the beneficiary to undergo preliminary diagnosis and basic tests.

Step 3:

The Network Hospital, based on the diagnosis, admits the patient and sends preauthorization request to the Insurance company and the Aarogyasri Health Care Trust.

Step 4:

Specialists of the Insurance Company and the Trust examine the preauthorization request and approve preauthorization if all the conditions are satisfied.

Step 5:

The Network Hospital extends cashless treatment and surgery/therapy to the beneficiary.

Step 6:

Network Hospital after performing the surgery/therapy forwards the original bill, discharge summary with signature of the patient and other relevant documents to Insurance Company for settlement of the claim.

Step 7:

Insurance Company scrutinize the bills and gives approval for the sanction of the bill.

Working Pattern

Working Pattern

TRAUMA AND ACCIDENTS SURGERIES

6 TRAUMA & ACCIDENTS SURGERIES (Where major surgical procedure is involved; excluding accident trauma cases covered under the MV Act.)
164 6.1 Neurosurgical Trauma 30,000
165 6.2 Polytrauma 50,000
166 6.3 Longbone Fractures (Surgical Correction) 15,000

BURNS

5 BURNS
5.1 30% - 50% Burns
157 5.1.1 upto-40% with Scalds( Conservative) 35,000
158 5.1.2 upto-40% Mixed Burns(with Surgeries) 50,000
159 5.1.3 upto-50% with Scalds (Conservative) 60,000
160 5.1.4 upto-50% Mixed Burns( with Surgeries) 70,000
5.2 Above 50% Burns
161 5.2.1 upto-60% with Scalds (Conservative) 80,000
162 5.2.2 Up to-60% Mixed Burns (with Surgeries) 1,00,000
163 5.2.3 Above 60% Mixed Burns (with Surgeries) 1,20,000

NEUROSURGERY

4 NEUROSURGERY
119 4.1 Craniotomy and Evacuation of Haematoma –Subdural 40,000
120 4.2 Craniotomy and Evacuation of Haematoma –Extradural 40,000
121 4.3 Evacuation of Brain Abscess-burr hole 40,000
122 4.4 Excision of Lobe (Frontal,Temporal,Cerebellum etc.)40,000
123 4.5 Excision of Brain Tumours -Supratentotial 40,000
124 4.6 Excision of Brain Tumours -Subtentorial 45,000
125 4.7 Surgery of Cord Tumours 25,000
126 4.8 Ventriculoatrial /Ventriculoperitoneal Shunt 20,000
127 4.9 Excision of Cervical Inter-Vertebral Discs 25,000
128 4.10 Twist Drill Craniostomy 25,000
129 4.11 Subdural Tapping 25,000
130 4.12 Ventricular Tapping 25,000
131 4.13 Abscess Tapping 20,000
132 4.14 Vascular Malformations 40,000
133 4.15 Peritoneal Shunt 15,000
134 4.16 Atrial Shunt 15,000
135 4.17 Meningo Encephalocele 25,000
136 4.18 Meningomyelocele 25,000
137 4.19 C.S.F. Rhinorrhoea 20,000
138 4.20 Cranioplasty 30,000
139 4.22 Posterior Cervical Dissectomy 15,000
140 4.23 Anterior Cervical Dissectomy 15,000
141 4.24 Meningocoele Excision 25,000
142 4.25 Ventriculo-Atrial Shunt 20,000
143 4.26 Anterior Cervical Spine Surgery with fusion 45,000
144 4.27 Anterior Lateral Decompression 30,000
145 4.28 Cervical or Dorsal Laminectomy 25,000
146 4.29 Combined Trans-oral Surgery & CV Junction Fusion 30,000
147 4.30 C.V. Junction Fusion 20,000
148 4.31 Depressed Fracture 15,000
149 4.32 Discectomy 25,000
150 4.33 Spinal Fusion Procedure 50,000
151 4.34 Spinal Intra Medullary Tumours 50,000
152 4.35 Spinal Bifida Surgery Major 20,000
153 4.36 Spina Bifida Surgery Minor 15,000
154 4.37 Stereotactic Procedures 20,000
155 4.38 Trans Sphenoidal Surgery 20,000
156 4.39 Trans Oral Surgery 25,000

RENAL (KIDNEY)

kidney 1: A longitudinal section, B nephron and adjacent blood vessels; 1 renal papilla, 2 renal column, 3 capsule, 4 renal pyramid, 5 calyx, 6 ureter, 7 renal pelvis, 8 renal vein, 9 renal artery, 10 interlobar artery, 11 arcuate artery, 12 interlobular artery, 13 interlobar vein, 14 cortex, 15 interlobular vein, 16 renal sinus, 17 arcuate vein, 18 medulla, 19 vasa recta, 20 loop of Henle, 21 collecting duct, 22 arcuate vein, 23 arcuate artery, 24 proximal convoluted tubule, 25 glomerulus, 26 Bowman's capsule, 27 distal convoluted tubule





3 RENAL
106 3.1 HaemoDialysis (Pre Transplant only) 1,000
107 3.1.1 A.V. Fistule 3,000
108 3.2 Renal Transplantation surgery 1,30,000
109 3.2.1 Post Transplant immunosuppressive Treatment upto 1 year 60,000
110 3.3.1 Open Pylolithotomy 10,000
111 3.3.2 Open Nephrolithotomy 10,000
112 3.3.3 Open Cystolithotomy 10,000
113 3.3.4 PCNL 10,000
114 3.3.5 Laparoscopic Pylolithotomy 15,000
115 3.3.6 ESWL 10,000
116 3.3.7 Nephrostomy 2,000
117 3.3.8 DJ stunt 1,000
118 3.4 Renal Angioplasty 60,000

COBALT 60 THERAPY

2A Cobalt 60 Therapy (only as pre / post surgery Therapy protocol)
94 2.A.1 Radical Treatment 20,000
95 2.A.2 Palliative Treatment 10,000
96 2.A.3 Adjunctive Therapy 15,000
2B Linear Accelerators (only as pre / post surgery Therapy protocol)
97 2.B.1 Radical Radiotherapy 25,000
98 2.B.2 Palliative Radiotherapy 15,000
2.C Brachy Therapy (only as pre / post surgery Therapy protocol)
99 2.C.1 Intracavitary 3,000 per application
100 2.C.2 Head & Neck 15,000
101 2.C.3 Breast 15,000
102 2.C.4 Soft Tissue Sarcoma 15,000
2.D Chemotherapy (only as pre / post surgery Therapy protocol)
103 2.D.1 Single Drug Therapy per day 500 per day
104 2.D.2 Multiple Drug Therapy per day 750 per day
105 2.D.3 Infusional Chemotherapy 2,000 per day