Following news reports of certain private hospitals refusing medical services to patients under the Ayushman Bharat scheme, the State Health Agency (SHA), J&K, today issued a clarification to reassure the beneficiaries of their rights and the support available to them.
In a statement, the SHA said it has established a robust and transparent grievance redressal mechanism to ensure that no eligible beneficiary is denied treatment under the Ayushman Bharat PM-JAY and AB PM-JAY SEHAT schemes.
“If any empanelled private or public hospital refuses to provide treatment under the scheme, beneficiaries are advised to immediately report the issue. Complaints can be registered by calling the toll-free helpline 104 for direct assistance and quick action. Additionally, grievances can be submitted online through the Centralized Public Grievance Redress and Monitoring System (CPGRAMS), Central Grievance Redressal and Management System (CGRMS) or the JK Samadhan Portal. If any hospital is found guilty of denying treatment or violating scheme guidelines, strict action is taken, including imposition of penalties, temporary suspension and even permanent de-empanelment from the scheme”.
“A dedicated Grievance Cell at SHA monitors and resolves complaints on a priority basis. Additionally, the State Anti-Fraud Unit (SAFU) conducts regular follow-up calls with the patients to verify whether they received the entitled cashless treatment”.
It is important to note that all treatment packages under the Ayushman Bharat scheme are scientifically designed and standardized by the expert committees under the National Health Authority (NHA). These packages define clear medical protocols, costs and durations and are applicable uniformly across all empanelled hospitals in the country. Hospitals are not permitted to alter or overcharge for these packages, ensuring transparency and uniform quality of care, the statement said.
“As per the scheme guidelines, no empanelled hospital is allowed to deny treatment or demand payment for services covered under the scheme. Any such act whether in the form of service denial or asking for money constitutes a serious violation. Hospitals found guilty are liable to face strict action, including penalties, suspension or permanent de-empanelment from the scheme”.
The SHA has urged all the beneficiaries to register their Grievances/Complaints through available channels. For any help or complaints, beneficiaries can call 104.