Step 1: Check the referral itself before travelling
Confirm beneficiary name, referral date, speciality, hospital/health-care organisation and the treatment/investigation advised. Also verify that the chosen hospital and required speciality are currently empanelled. Carry the referral/authorisation and ECHS card or valid entitlement document.
Step 2: Use the current referral rules, not an old 30-day rule automatically
ECHS issued revised referral guidelines on 12 March 2025. The newer clarification provides longer/specific routes in several situations, including a three-month referral window for investigations/treatment advised after specialist referral, while cancer, radiotherapy/chemotherapy, diabetes, hypertension and other cardiac-disease referrals continue with 180-day validity. Because the applicable validity depends on the case, check the latest referral policy for your treatment type.
Step 3: If the hospital asks you to return for another referral
Ask exactly what requires the fresh referral or approval: consultation, investigation, listed/unlisted procedure, admission or extension. Under the revised rules, not every investigation advised by an empanelled specialist requires the beneficiary to return to the polyclinic. Preserve the specialist advice and contact the referring polyclinic/Regional Centre if the hospital applies an older rule.
Step 4: If admission is required
For planned admission to an empanelled private hospital, referral/authorisation requirements still apply unless the case falls within an emergency route or another specific exemption. If the specialist converts OPD treatment into admission, confirm the authorisation before proceeding when the situation is not an emergency.
Step 5: If treatment cannot finish within the referral period
Do not alter dates or obtain an informal extension from the hospital. Contact the referring polyclinic/competent ECHS authority before validity expires and keep the specialist recommendation showing why continuation is required. Some categories have specific longer validity or follow-up provisions.
Step 6: For beneficiaries aged 70 years and above
The current clarification allows ECHS beneficiaries aged 70 years and above to seek direct OPD specialist consultation at empanelled private hospitals without a referral. Specific approval rules may still apply to unlisted investigations/procedures in non-emergency conditions, so check the current policy before planned high-cost treatment.
Step 7: If the hospital refuses cashless treatment or asks for cash
Do not treat this as only a referral problem. ECHS currently states that cash demand, bed denial, poor service, negligence, substandard treatment or other difficulty at an empanelled hospital should be reported to the Director Regional Centre immediately. Keep the referral and evidence of the demand/problem.
Step 8: Escalate with the full treatment trail
Send the beneficiary details, Parent Polyclinic, referral copy, specialist advice, hospital name, dates, authorisation/approval details and screenshots/messages. Start with the referring polyclinic/Regional Centre. Do not delay urgent medical care merely to resolve paperwork; emergency treatment has a separate ECHS route.