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Access
Scheme & funding access
Ayushman Bharat, CGHS, ESI, state schemes, employer cover and company access programmes, worked, not mentioned.
What it is
Most Indian families entitled to funded treatment never receive it, because entitlement is not the same as access. Empanelment lists, package rates, pre-authorisation, referral chains and documentation defeat people who are already dealing with a diagnosis.
Separately, pharmaceutical patient-access programmes can reduce the cost of specific expensive drugs substantially. They are almost never volunteered.
When it is used
- Before starting any expensive treatment
- Where a written estimate makes a course look unaffordable
- When a scheme claim has been refused
- When an expensive targeted or biological drug is proposed
How the decision is made
- Which scheme you are actually eligible for, and at which empanelled centre.
- Whether the scheme package covers the regimen your board recommended, or a different one.
- Which access programme or biosimilar applies to the specific drug proposed.
Worked here at the cost desk; treatment at the empanelled centre the scheme requires.
Who does what
What we handle, and what happens elsewhere
KPCIRC handles
- An eligibility check across central, state and employer schemes
- Documentation assembled and the pre-authorisation actually filed
- Patient-access programme applications, drug by drug
- The whole-course cost restated after everything applied
- Escalation when a claim is refused
Performed and billed elsewhere
- The treatment itself, at scheme rates
- Hospital-side claim processing
- We charge for the cost desk as a stated service. We are not paid by any scheme, hospital or pharmaceutical company for routing you anywhere.
Questions to ask your own doctor
Take these with you. They work whether or not you are treated here.
- Which schemes am I eligible for?
- Does the scheme cover the regimen you recommended?
- Is there a patient-access programme for this drug?
- What is the realistic total after everything?
Support that goes with it
Where this is used
Cancers this commonly forms part of
Breast cancer
Including hormone-receptor positive, HER2-positive and triple-negative disease
Lung & thoracic cancer
Non-small cell and small cell lung cancer, mesothelioma, thymic tumours
Colorectal cancer
Colon and rectal cancer, bowel cancer
Leukaemia
Acute and chronic leukaemias. ALL, AML, CLL, CML
Lymphoma
Hodgkin and non-Hodgkin lymphoma
Cervical cancer
Cancer of the cervix
Oral, head & neck cancer
Mouth, tongue, cheek, gum, throat, voice box and salivary gland cancers
Not sure this is the right option for you?
That is exactly what a second opinion is for. Bring what you have, we will tell you what is missing and what the alternatives actually are, in writing.