The court affirmed that surgical fees included in package pricing can't be claimed separately under the CGHS scheme.

1. The present Revision Petition (RP) has been filed by the Petitioner against Respondent asdetailed above, under S.21 (b) of Consumer Protection Act 1986, against the order dated 20.7.2022 of the State Consumer Disputes Redressal Commission Maharashtra (hereinafter referred to as the ˜State Commission'), in First Appeal (FA) No. A / 19/235 in which order dated11.9.2018 of South Mumbai District Consumer Disputes Redressal Forum (hereinafter referred to as District Forum ) in Consumer Complaint (CC) No. 197 of 2017 was challenged, inter alia praying for setting aside the Order dated 20.7.2022 of the State Commission and uphold the order of the District Forum dated 11.9.2018.

2. While the Revision Petitioner (hereinafter also referred to as Complainant) was Respondent and the Respondents (hereinafter also referred to as OPs) were Appellants in the said FA No. A / 19/235 before the State Commission, the Revision Petitioner was Complainant and Respondents were OPs before the District Forum in the CC No. 197 of 2017.

3. Notice was issued to the Respondents on 02.12.2022. Parties filed Written Arguments / Synopsis on 31.7.2023 and 22.8.2023 respectively.

4. Brief facts of the case, as emerged from the RP, Order of the State Commission, Order of the District Forum and other case records are that Complainant is member of OP(s) since October, 2004. On 2.2.2016, the complainant suffered acute chest pain and was admitted in Sir H.N.Reliance Foundation Hospital at Girgaon, Mumbai. On 3.2.2016, he had open heart surgery under the treatment and supervision of Dr. Sudhansu Bhattacharyya. He was discharged on 14.02.2016. The hospital had issued final invoice dated 14.2.2006 for Rs.10,53,033 inclusive of Dr. Sudhansu Bhattacharyya's fees of Rs. 6,00,000. The complainant had private medical insurance for sum of Rs. 2.00 lakhs with ICICI Lombard Insurance Co. He received reimbursement of Rs. 2 lakhs from ICICI Lombard Insurance Co. on16.3.2016. The Complainant submitted remaining bill of Rs. 8,53,033 to OP No. 1. On 16.4.2016, OP No. 1 approved and reimbursed a sum of Rs. 73,133 to the complainant. The remaining amount of medical expenses was refused by the OPs. The complainant sent emails to Regional Director of OP No. 2 on 1.9.2016 and 19.9.2016 but no action was taken. Complainant requested that on the basis of order passed by Hon'ble High Court of Mumbai in identical case, his claim be considered. Accordingly, complainant wrote letter to Lt Gen.Rakesh Sharma, to whom MD of OPs report but no positive response was received from the OPs. The Secretary, Ex - Servicemen Welfare Department instructed OP No. 1 to take action on top priority but after multiple follow - ups and several emails, head Quarter, ECHS took up the matter and reviewed and approved further claim of complainant to the extent of Rs. 1,75,506 but OPs failed and neglected to reimburse the amount of surgeon fees to the extent of Rs. 6.00 lacs. Being aggrieved of the said refusal, the Petitioner filed a Complaint before the District Forum.

5. Order dated 11.9.2018 in CC No. 197 of 2017, the District Commission partly allowed the Complaint. Being aggrieved by the said order of the District Forum dated 11.9.2018, the Respondents appealed in State Commission and the State Commission vide order dated 20.7.2022 in Appeal No. 19 of 235, partly allowed the Appeal. Hence, the Petitioner herein is before this Commission in Revision Petition.

6. Petitioner has challenged the said Order dated 20.7.2022 of the State Commission mainly / inter alia on following grounds:

(i) All the bills were produced by the Petitioner for reimbursement before