The Pradhan Mantri Ayushman Bharat Yojana stands as one of the most ambitious government health initiatives in India. With the vision of providing accessible and affordable healthcare for all, this scheme ensures that millions of Indians get financial protection against high medical costs.
Despite these robust provisions, many beneficiaries have faced challenges where empanelled hospitals refuse to provide free treatment to Ayushman cardholders. This article provides an in-depth look at Ayushman Bharat Yojana, how to address hospital refusals, and the steps required both for claiming benefits and obtaining the Ayushman card.
What is Ayushman Bharat Yojana?
Ayushman Bharat Yojana, officially known as the Pradhan Mantri Jan Arogya Yojana (PM-JAY), is designed to offer health insurance coverage to India’s most vulnerable populations. It provides a cover of up to Rs 5 lakh per family per year for secondary and tertiary care hospitalization. The scheme covers a broad range of treatments—everything from surgeries to treatments for chronic conditions—across both public and enlisted private hospitals. There is no cap on family size, age, or existing medical conditions, ensuring inclusivity.
Common Issues Faced by Ayushman Cardholders
Despite clear government instructions, some hospitals have reportedly denied cashless treatment to Ayushman cardholders. These denials often leave families vulnerable during emergencies and undermine the scheme’s core purpose. Reasons cited by hospitals include technical errors, pending scheme payments, or administrative hurdles. Knowing your rights and the correct procedure to address such issues is essential for beneficiaries.
How to Lodge a Complaint Against Hospital Treatment Denial
If your Ayushman card is refused by an empanelled hospital, immediate action is crucial. The government offers a streamlined process for grievance redressal to empower beneficiaries:
- Online Complaint Submission:
Go to the official grievance redressal portal and find the “Register Your Grievance” section. Fill in the requisite details, such as your Ayushman card number, hospital information, and a brief description of your complaint. Submitting your complaint here sets the official process in motion, prompting an inquiry into the hospital’s conduct. - National Toll-Free Helpline:
You may also call the national helpline at 14555. For faster state-specific support, use alternate helpline numbers such as 104 in Bihar, 180018004444 in Uttar Pradesh, or 18002332085 in Madhya Pradesh. The helpline allows real-time reporting and guidance on next steps. - UMANG App:
The government’s UMANG mobile app provides digital access for filing grievances under the Ayushman Bharat section. This digital solution is convenient for tech-savvy users and can be accessed anywhere.
Effective Complaint Reporting: Best Practices
To strengthen your grievance and ensure rapid action, it’s advisable to follow these tips:
- Gather Documentation: Always keep your Ayushman card ready and safely store hospital admission records or any official correspondence with the hospital.
- Collect Evidence: If possible, take photographs or videos as proof of the denial. This evidence can support your case.
- Track Your Complaint: After registering a grievance, note down the complaint or grievance ID. Follow up promptly if there is no response within the specified time.
Do not delay action if you face denial, as quick reporting increases the likelihood of timely resolution and disciplinary action against erring hospitals.
Understanding the Benefits of the Ayushman Card
The Ayushman card provides more than just financial relief—it offers security and dignity. Benefits include:
- Coverage for hospital expenses up to Rs 5 lakh per family, per year.
- No cap on number of family members, age, or pre-existing illnesses.
- Coverage for a wide range of health issues, including surgeries, treatments for serious illnesses, and pre/post-hospitalization expenses.
- Cashless treatment at both government and empanelled private hospitals, ensuring smooth and quick access to care.
How to Apply for an Ayushman Card
Those who have not yet availed themselves of the scheme can easily apply for an Ayushman card. Here’s a step-by-step process:
- Visit the nearest Common Service Centre (CSC): Locate your closest CSC where a designated officer will assist with the application.
- Eligibility Verification: The officer will check your eligibility based on socio-economic parameters.
- Document Submission: Provide the necessary documents for verification; these usually include identification proof and residence details.
- Processing Application: After successful document verification, your application will be processed in the system.
- Download Your Card: Once approved, you will be notified to download your Ayushman card, which can then be used for hospital admissions and treatment.
The Pradhan Mantri Ayushman Bharat Yojana serves as a major lifeline for millions across India, offering comprehensive health cover and ensuring no one is left behind. However, beneficiaries need to be aware of their rights and the correct avenues for grievance redressal if hospitals deny them the care due under this scheme. By understanding the complaint process and keeping the necessary documentation ready, you can make the most of the Ayushman Bharat Yojana and secure quality healthcare for your family.
