Why the letter outranks the treatment
ESIC pays empanelled hospitals for care it authorised. The referral letter is that authorisation. Treatment that wanders beyond the letter’s scope — different specialty, longer stay, added procedures — needs fresh authorisation, or it is at risk regardless of clinical merit.
Emergency is an exception with a clock
Genuine emergencies can be admitted first, but the intimation to ESIC has a deadline measured in hours, not days. The desk that treats ESIC intimation as next-morning paperwork is converting payable emergencies into disputes.
| Item | Standard | Consequence / owner |
|---|---|---|
| Referral letter scope | Check specialty, procedure, duration at admission | Admission desk |
| Emergency intimation | Within the stated window, documented | Insurance desk |
| Stay extension | Request before the covered period lapses | Ward + insurance desk |
| Added procedures | Fresh authorisation before performing | Treating team + desk |
| Discharge documents | Match the authorisation trail exactly | Billing |
Extensions before, not after
If the stay will exceed what the referral supports, the extension request goes before the excess days occur. Retrospective extension requests invite exactly the scrutiny a running authorisation avoids.
What to do on Monday
- Put referral-scope check on the ESIC admission checklist.
- Set an intimation alarm for emergency admissions.
- Log every extension request date against the covered period.
Worked examples on this page are illustrative arithmetic on stated assumptions, not measured market statistics.