Date : 23-02-2024

To,

The Medical Superintendent,

Maniktala ESIC Hospital,

54, Bagmari Road, Kolkata – 700 054

Subject: Urgent Inquiry Regarding Payment Requests for Brain Scan Services for IP
[Patient's Name]

Ref : IP NO :

Dear Sir,,

We are writing to bring to your attention a matter of concern regarding [Patient's Name], an
Insured Person (IP), who has visited our hospital on several occasions for his current ongoing
treatment and further reported by the IP to us that he was advised to go for a brain scan.

It has come to our notice that during these visits, [Patient's Name] has been subjected to
requests for payment, despite the established rule that no charges are to be levied on IPs for
such scans. We have attached the relevant prescriptions details for your reference.

Given the severity of the situation, we kindly request clarification on the current procedure
for providing brain scan services to IPs and would appreciate your prompt guidance on the
matter. Additionally, we urge your intervention to ensure that [Patient's Name] is allowed to
undergo the necessary city scan without encountering any financial barriers.

Please provide your opinion in writing so that we may better understand the matter.

Your immediate attention to this issue is highly appreciated, and we look forward to your
guidance to ensure the well-being of [Patient's Name].

Thank you for your cooperation.

Sincerely,

[Your Name]

[Your Position]

[Your Contact Information]