Follow Up Information Follow Up Information

FOLLOW UP SERVICES FOR AAROGYASRI BENEFICIARIES

AIM:
 

Scheme is aimed at providing coverage for follow-up services where specifically needed, so as to gain optimum benefit from the Surgery/Therapy and to avoid complications by providing system / disease specific package for one year follow-up for consultation, investigations, drugs etc.,

Patients require follow-up services for certain procedures in order to gain optimum benefit from the Surgery/Therapy and to avoid complications,. Presently Trust is providing follow-up drugs to these beneficiaries through Network Hospitals, but changes in the follow-up services are required in order to streamline the services.

Hence the technical committee of the Trust in consultation with specialists identified specific procedures for follow-up, reviewed the present policy and suggested change by providing system / disease specific package. Accordingly the following guidelines and packages are formulated for follow-up services by Network Hospitals under the scheme.


GUIDELINES:
 
  • Package covers entire cost of follow-up. ,i.e., consultation, medicines, diagnostic tests etc.,
  • Follow-up treatment shall be entirely cashless to the patient and will start on 11th day after his discharge and will continue for one year after 11th day of discharge.
  • No formal preauthorization is required.
  • For operational convenience package amount is apportioned to 4 quarters. Since frequency of visits and investigations are common during first quarter, more amount is allocated for first installment
  • However the entire package amount must be treated as single entity and hospital shall not refuse to conduct investigations free of cost under the package any time during one year follow-up period.
  • Patient follow-up visits may be spaced according to medical requirement, but approval will be given for one quarter.
  • MEDCO along with AAROGYAMITHRA shall facilitate patient follow-up.

PROCESS FLOW:
 
  1. Patient is counselled at the time of discharge about the importance of follow-up and availability of free services by the hospital
  2. The first follow-up date shall be on 11th day after discharge as first 10 days treatment is provided to the patient as per disease package.
  3. MEDCO and AAROGYAMITHRA shall specifically inform the patient about the date and time of subsequent follow-up visits, duly making entry in patient follow-up in the trust portal based on standard medical protocols.
  4. Hospital shall send proof of follow-up services of patient and submit to Trust once in three months for each quarter to trust portal by uploading(see the work flow)
    • Details of consultation
    • Details of Medicines given
    • Investigations done
    • Acquittance from patients in the prescribed format
    • Photograph showing acquittance of Medicines to the patient
    • Bills for medicines and diagnostics (to be scanned and uploaded)
  5. Trust shall settle claim as per package amount based on above proof.
  6. Hospital shall claim follow-up package only for the disease mentioned along with the code and no other claim shall be entertained by Trust.
 
FOLLOW-UP PACKAGES
S.No Code SYSTEM Package First Installment Subsequent
3 Installments
SURGICAL
1 SF1.1.5.6 Total Thyroidectomy 3000 1200 600
2 SF1.4.2 Portocaval Anastomosis 10000 4000 2000
3 SF1.6.1 Operation of Adernal 4000 1600 800
glands bilateral
4 SF1.7.2 Splenorenal 10000 4000 2000
Anastomosis
5 SF1.7.3 Warren shunt 10000 4000 2000
6 SF6.8.2 Spleenectomy + Devascularisation + Spleno Renal Shunt 10000 4000 2000
7 SF6.9.1 Lap- Pancreatic Necrosectomy 8000 3500 1500
8 SF6.9.3 Pancreatic Necrosectomy (open) 8000 3500 1500
9 SF7.1.1.1 Coronary Balloon Angioplasty 10000 4000 2000
10 SF7.1.1.3 Coronary Balloon Angioplasty with Drug eluting stent(00.45) 10000 4000 2000
11 SF7.1.7.1 Renal Angioplasty 10000 4000 2000
12 SF7.1.7.2 Peripheral Angioplasty 10000 4000 2000
13 SF7.1.7.3 Vertebral Angioplasty 10000 4000 2000
14 SF7.2.1.1 Coronary Bypass Surgery 10000 4000 2000
15 SF7.2.1.2 Coronary Bypass Surgery-post Angioplasty 10000 4000 2000
16 SF7.2.1.3 CABG with IABP pump 10000 4000 2000
17 SF7.2.1.4 CABG with aneurismal repair 10000 4000 2000
18 SF7.2.9.1 With Prosthetic Ring 10000 4000 2000
19 SF7.2.9.2 Without Prosthetic Ring 10000 4000 2000
20 SF7.2.9.3 Open Pulmonary Valvotomy 10000 4000 2000
21 SF7.2.9.4 Closed mitral valvotomy 10000 4000 2000
22 SF7.2.9.5 Mitral Valvotomy (Open) 10000 4000 2000
23 SF7.2.10.1 Mitral Valve Replacement (With Valve) 10000 4000 2000
24 SF7.2.10.2 Aortic Valve Replacement (With Valve) 10000 4000 2000
25 SF7.2.10.3 Tricuspid Valve Replacement 10000 4000 2000
26 SF7.2.10.4 Double Valve Replacement (With Valve) 10000 4000 2000
27 SF7.2.19.1 Carotid Embolectomy 10000 4000 2000
28 SF8.6.4 Encephalocele 4000 1600 800
29 SF8.8.12 Surgeries on adrenal gland in Children 4000 1600 800
30 SF9.2.1 Open Pyelolithotomy 2000 800 400
31 SF9.2.2 Open Nephrolithotomy 2000 800 400
32 SF9.2.3 Open Cystolithotomy 2000 800 400
33 SF9.2.4 Laparoscopic Pyelolithotomy 2000 800 400
34 SF9.3.1 Cystolithotripsy 2000 800 400
35 SF9.3.2 PCNL 2000 800 400
36 SF9.3.3 ESWL 2000 800 400
37 SF9.3.4 URSL 2000 800 400
38 SF9.7.1 Endoscope Removal of stone in Bladder 2000 800 400
39 SF9.9.1 Transurethral resection of prostate (TURP) 2000 800 400
40 SF9.9.2 TURP Cyst lithotripsy 2000 800 400
41 SF9.9.3 Open prostatectomy 2000 800 400
42 SF10.1.1 Craniotomy and Evacuation of Haematoma –Subdural 8000 3200 1600
43 SF10.1.2 Craniotomy and Evacuation of Haematoma –Extradural 8000 3200 1600
44 SF10.1.3 Evacuation of Brain Abscess-burr hole 8000 3200 1600
45 SF10.1.4 Excision of Lobe (Frontal,Temporal,Cerebellum etc.) 8000 3200 1600
46 SF10.1.5 Excision of Brain Tumor Supratentorial 8000 3200 1600
47 SF10.1.6 Parasagital 8000 3200 1600
48 SF10.1.7 Basal 8000 3200 1600
49 SF10.1.8 Brain Stem 8000 3200 1600
50 SF10.1.9 C P Angle Tumor 8000 3200 1600
51 SF10.1.10 Other tumors 8000 3200 1600
52 SF10.1.11 Excision of Brain Tumors –Subtentorial 8000 3200 1600
53 SF10.1.12 Ventriculoatrial /Ventriculoperitoneal Shunt 8000 3200 1600
54 SF10.1.14 Subdural Tapping 8000 3200 1600
55 SF10.1.15 Ventricular Tapping 8000 3200 1600
56 SF10.1.16 Abscess Tapping 8000 3200 1600
57 SF10.1.17 Vascular Malformations 8000 3200 1600
58 SF10.1.18 Peritoneal Shunt 8000 3200 1600
59 SF10.1.19 Atrial Shunt 8000 3200 1600
60 SF10.1.20 Meningo Encephalocele 8000 3200 1600
61 SF10.1.21 Meningomyelocele 8000 3200 1600
62 SF10.1.25 Ventriculo-Atrial Shunt 8000 3200 1600
63 SF10.1.26 Excision of Brain Abcess 8000 3200 1600
64 SF10.1.27 Aneurysm Clipping 8000 3200 1600
65 SF10.1.28 External Ventricular Drainage (EVD) 8000 3200 1600
66 SF10.3.2 Trans Sphenoidal Surgery 8000 3200 1600
67 SF10.3.3 Trans Oral Surgery 8000 3200 1600
68 SF10.4.1 Endoscopy procedures 8000 3200 1600
69 SF10.4.2 Intra-Cerebral Hematoma evacuation 8000 3200 1600
70 SF10.7.1 Temporal Lobectomy 8000 3200 1600
71 SF10.7.2 Lesionectomy type 1 8000 3200 1600
72 SF10.7.3 Lesionectomy type 2 8000 3200 1600
73 SF10.7.4 Temporal lobectomy plus Depth Electrodes 8000 3200 1600
74 SF15.2.1.1 Stay in General Ward@Rs.500/day 8000 3200 1600
75 SF15.2.1.2 Stay in Neuro ICU@Rs.4000/day 8000 3200 1600
76 SF15.2.2 Surgical Treatment (Up to) 8000 3200 1600
 
MEDICAL

S.No

Code

SYSTEM

Package

First Instalment

Subsequent 3 Instalments

1

MF1.1

Acute severe asthma with Acute respiratory failure

10000

4000

2000

2

MF1.2

COPD Respiratory Failure (infective exacerbation)

10000

4000

2000

3

MF4.1.12

Term baby with persistent pulmonary hypertension Ventilation-HFO Hyperbilirubinemia Clinical sepsis

6000

3000

1000

4

MF4.1.16

Term baby with seizures ventilated

5000

2000

1000

5

MF4.2.1.5

Acute Severe Asthma
(Ventilated)

4000

1600

800

6

MF4.2.2.5

Infective Endocarditis

10000

4000

2000

7

MF4.2.3.1

Meningo- encephalitis
(Non Ventilated)

6500

2000

1500

8

MF4.2.3.2

Meningo- encephalitis
( Ventilated)

6500

2000

1500

9

MF4.2.3.3

Status Epilepticus

6500

2000

1500

10

MF4.2.3.5

Intra cranial bleed

6500

2000

1500

11

MF4.3.2.1

Congenital heart disease with congestive cardiac failure

5000

2000

1000

12

MF4.3.2.2

Acquired heart disease with congestive cardiac failure

5000

2000

1000

13

MF4.3.3.1

Steroid Resistant Nephritic syndrome
Complicated or Resistant

5000

2000

1000

14

MF4.3.4.3

Anaemia of unknown cause

5000

2000

1000

15

MF4.3.5.1

Pyogenic meningitis

5000

2000

1000

16

MF4.3.5.2

Neuro tuberculosis

5000

2000

1000

17

MF4.3.5.3

Neuro tuberculosis with ventilation

5000

2000

1000

18

MF4.3.6.1

Convulsive Disorders/Status Epilepticus (Fits)

5000

2000

1000

19

MF4.3.6.3

Encephalitis / Encephalopathy

5000

2000

1000

20

MF5.1.1

Acute Mi (Conservative Management Without Angiogram)

10000

4000

2000

21

MF5.1.2

Acute Mi (Conservative Management With Angiogram)

10000

4000

2000

22

MF5.1.3

Acute Mi With Cardiogenic Shock

10000

4000

2000

23

MF5.1.4

Acute Mi Requiring Iabp Pump

10000

4000

2000

24

MF5.1.5

Refractory Cardiac Failure

10000

4000

2000

25

MF5.2

Infective Endocarditis

10000

4000

2000

26

MF5.4

Complex Arrhythmias

10000

4000

2000

27

MF6.2

Nephrotic Syndrome

5000

2000

1000

28

MF7.1

ADEM or Relapse in Multiple sclerosis

5000

2000

1000

29

MF7.2

CIDP

5000

2000

1000

30

MF7.3

Hemorrhagic Stroke/Strokes

5000

2000

1000

31

MF7.4

Ischemic Strokes

5000

2000

1000

32

MF7.6

NEUROINFECTIONS -Fungal Meningitis

5000

2000

1000

33

MF7.7

NEUROINFECTIONS -Pyogenic Meningitis

5000

2000

1000

34

MF7.8

NEUROINFECTIONS -Viral Meningoencephalitis ( Including Herpes encephalitis)

5000

2000

1000

35

MF7.9

Neuromuscular (myasthenia gravis)

4000

1600

800

36

MF8.4

Interstitial Lung diseases

10000

4000

2000

37

MF8.5

Pneumoconiosis

10000

4000

2000

38

MF9.1

Pemphigus / Pemphigoid

3500

1400

700

39

MF10.1

SLE (SYSTEMIC LUPUS ERYTHEMATOSIS)

6000

2400

1200

40

MF10.2

SCLERODERMA

6000

2400

1200

41

MF10.3

MCTD MIXED CONNECTIVE TISSUE DISORDER

6000

2400

1200

42

MF10.4

MCTD MIXED CONNECTIVE TISSUE DISORDER

6000

2400

1200

43

MF10.5

VASCULITIS

6000

2400

1200

44

MF11.2.1

Hypopitutarism

8000

3500

1500

45

MF11.2.2

Pituitary - Acromegaly

6500

2000

1500

46

MF11.2.4

Delayed Puberty Hypogonadism
(ex.Turners synd, Kleinfelter synd)

7000

2500

1500

47

MF12.9

Gastric varices

7000

2500

1500

48

MF12.13

Chronic pancreatitis with severe pain

7000

2500

1500

49

MF12.15

Cirrhosis with Hepatic Encephalopathy

7000

2500

1500

50

MF12.16

Cirrhosis with hepato renal syndrome

7000

2500

1500