HMF Success Stories

Community based Health Mutual Fund-Success Story

Name of the policy holder:  Mrs Anita Premnath Sakale

                Member since: 2 years

Name of the claimant: Mr Premnath Sakale

                 Relation with the policy holder: Husband

Age:  47 years

Sex: Male

Branch: .Karvenagar

Area: Mavale aali -Karvenagar

Implementing org:-Annapurna Pariwar Vikas Samvardhan.

Illness:  D12-L1 compression #, pedicular screw and rod fixation due to accidental fall

Health Incident and period:- Nov 08Mrs Anita Sakale works as a housemaid while Mr. Sakale is a Painter by profession. One day while on work Mr Sakale fell from third floor .Looking at his serious conditions the co-workers admitted him to a nearby private hospital. He was admitted in ICU department and was taken for x-ray examination for diagnosis of his condition. The x-ray revealed serious injury to his vertebrae’s that required immediate surgery costing Rs 3 lakh. (The one day admission in ICU ward in the private hospital had itself costed Rs 15 thousand.)Anita could no way afford this cost .

Health Support felt/required and problems:

The same operative if done in the network hospital would only reduce the cost by 20 %.Anita and her family was unable to bear the cost of treatment.

 Health Problem resolution:

Anita then contacted the Service executive  who after getting to know her condition guided her to get the patient admitted to Sassoon Hospital (Public  hospital)

 Use of referrals Guidance: To make sure  that the member get’s immediate access to treatment the SE gave her the referral letter and also contacted the social worker in the hospital to inform that she was sending a serious patient who immediately needs to be operated.

The operation required some surgical material which costed Rs 26 thousand .Anita did not have the required cash nor it was possible to get it by the next day. The social worker took her responsibility as she was a HMF member and asked the surgical store officer to provide the lady with the necessary material without paying a single rupee upfront.

Mr Sakale was operated the very next day .

 Treatment/Cost: The entire operation costed Rs 35 thousand only instead of Rs 3 lakhs

 Reimbursement from the Health mutual:

Anita’s health incident was discussed in the monthly meeting. The community decided to reimburse Rs 15 thousand to Mrs Sakale(As per the reimbursement category)  as she had followed the referral system and also used the Public hospital for treatment.

 Member’s feedback with photo:

Anita was deeply moved by the timely support she got by being a HMF member. She cannot express it in words but she said ‘’ If I was not a HMF member I would have to sell the only assets I had –My house”.