Parliament Question: Denial of Treatment to Ayushman Card Holders

GOVERNMENTOFINDIA MINISTRYOFHEALTH AND FAMILYWELFARE DEPARTMENTOFHEALTH ANDFAMILYWELFARE LOK SABHA UNSTARREDQUESTION NO. 4691 TOBE ANSWERED ON20TH MARCH, 2026 DENIALOFTREATMENTTO AYUSHMANCARD HOLDERS †4691.SHRIRAKESH RATHOR: Will the Minister of HEALTHAND FAMILYWELFAREbe pleased tostate: (a) whether the Government is aware of the investigation reports published in January- February2026,which revealed cases of outright denialof treatmenttoAyushman cardholders bylisted private hospitals in Delhi, Uttar PradeshandPunjab; (b) if so, the detailsthereof; (c) whether it is a fact that many private hospitals are dropping out of the scheme due to inordinate delays in reimbursement and unreasonable package rates, if so, the details thereof andthe reasons therefor; (d) the actual admission rate inprivate hospitals compared tothe millions of Ayushman cards issued; (e) the punitive action taken by the Government against hospitals that demand cash from eligiblebeneficiaries or refuse emergencytreatment; and (f) the Government's actionplanfor expeditioussettlement of pendingclaims? ANSWER THE MINISTER OFSTATEIN THE MINISTRYOFHEALTHAND FAMILYWELFARE (SHRIPRATAPRAOJADHAV) (a) to (f): As per the empanelment guidelines under Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), empanelled hospitals cannotdeny treatment to eligible beneficiaries. In cases of any irregularities in availing treatment or denial of treatment by an empanelled hospital, beneficiaries can register their grievances through the Centralized Grievance Redressal Management System (CGRMS) or the 24×7 toll-free helpline number 14555. Under AB-PMJAY, such grievances are monitored through a three-tier grievance redressal mechanism at the District, State and National level. At each level, designated nodal officers andGrievance Redressal Committees are inplace toexamineandresolve the grievances.Under AB-PMJAY, hospital empanelment is a continuous process and is undertaken by the implementing State/UT based on the requirements and availability of healthcare providers meeting the criteria as per empanelment guidelines of National Health Authority. The empanelmentof private hospitals underthe scheme isentirelyvoluntary. As on 28.02.2026, the empanelment of hospitals under the scheme has increased from 6,917 hospitals in FY 2018–19, comprising 3,013 public and 3,904 private hospitals, to 36,229 hospitals, comprising 19,483 public and 16,746 private hospitals. All eligible beneficiaries underthe scheme canavailtreatment through a network of these 36,229empanelledhospitals across the country. As on 28.02.2026, a total of 11.69 crore hospital admissions have been authorized under the scheme,including6.74crore admissions inprivate hospitals. Under the scheme, settlement of claims is a regular and uninterrupted process and claims are settled by respective State Health Agencies as per claim adjudication guidelines issued by National HealthAuthority. Fortimelysettlement of claims, the permissible turnaroundtime is within 15daysof claimsubmission forintra-state hospitals(hospitals locatedwithinthe State) and within 30 days of claim submission in case of portability claims (hospitals located outside the State). Under the scheme, claims submitted by empanelled hospitals are scrutinized based on the clinical documents, investigation reports and other supporting records, inaccordancewith the prescribed standard treatmentguidelines. *****