PMJAY Scheme Ayushman Card (img: Rawpixel, Civil Hospital - Ahmedabad)

Updated on Feb 14, at 1.51 p.m.

PMJAY Empanelled Private Hospital Association Gujarat (PEPHAG) on Feb 12 alleged in a presser that monetary dues to the tune of ₹800 cr are yet to be paid to the hospitals under the Pradhan Mantri Jan Arogya Yojana’s (PMJAY) Ayushman card since July 2021.

The association representatives said, “A total of ₹800 cr of Gujarat’s 789 private and trust-run hospitals have been due since the last three years. Hospitals are experiencing a cash crunch and are on the verge of bankruptcy owing to this payment delay. Over taking up this issue to various respective authorities, hospitals are only given consolations. The government should take action against these insurance companies.”

They added, “The previous company, The Oriental Insurance Company Ltd (OICL), owes ₹300 cr to the hospitals, while the current one, Bajaj Allianz Life Insurance, owes ₹500 cr.”

They further alleged. “Under policy 8, hospitals are granted a subpar amount or face rejection over their admissible Ayushman tariffs on their billing amount despite providing sufficient treatment to the patients. The Indian Medical Association (IMA) has also dismissed intervening in this issue.”

Insurance companies also allegedly slash 40% of the amount after the patient’s treatment, as per the association.

A doctor alleges, “Once an insurance company denied paying the amount with the excuse of not having a barcode of the removed implant. This barcode is available while implanting, but how can we avail of it during its removal? We had to take a loan from Bajaj, which itself is the insurance company, at an interest rate of 14%.”

It is noteworthy that more than 50 hospitals in the state have discontinued the ‘Ayushman Card’ scheme in their hospitals.

Patients are provided cashless treatment through this scheme at the top hospitals in the state, whose payment is made to them in 15 days by the insurance companies.

After which, an interest rate of 0.1% is levied over a week’s delay in this payment.

Updated on Dec 22, 2023, at 8.22 p.m.

As the state hospitals prepare themselves with the possibility of a looming  COVID-19 surge, the very institutions at the core of healthcare face operational issues.

Over the past six months, 400 private and charity-run hospitals in the state have not received payments from the insurance company for the medical treatments. These patients were administered under the Pradhan Mantri Jan Arogya Yojana (PMJAY) Ayushman card.

The hospitals reportedly face issues surrounding salary disbursements to the medical staff and maintaining the electronic-heavy amenities due to the delay in the payment in a government-run scheme.

Hospital and insurance company disputes

The PMJAY scheme was introduced to benefit the underprivileged requiring medical treatments.

The Gujarat government transferred the insurance proceedings in the PMJAY scheme from The Oriental Insurance Company Ltd (OICL) to Bajaj Allianz Life Insurance six months back.

As per reports, following this, the hospitals have not yet received the treatment amounts, despite the patients’ claims having already been passed since July this year. This raised  operational issues at the hospitals.

In one case, the insurance company owes a hefty payment of ₹17 lakh to a charitable trust-run hospital, sources stated.

When the hospital reached out, they were told that the delay was due to the transfer process after the change in the insurance company.

Reportedly, a plea was also sent to the state’s health authority by the hospitals, asking for a claim settlement from the insurance companies.

PMJAY Ayushman card: a boon or bane?

Apart from this,  the Ayushman card itself faces many snags. In several instances, the hospitals state, the card is either not activated or cannot be accessed on the scheme portal, which causes inconvenience .

Notably, Gujarat has around 2,827 hospitals where all treatments and even surgeries are available for free under the Ayushman Card. These include 1,975 government hospitals and 853 private hospitals in the state.

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