Bhopal (Madhya Pradesh): The promise of free, cashless treatment under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) is being openly flouted in Madhya Pradesh, with patients allegedly forced to deposit money before receiving care in empanelled private hospitals, defeating the very purpose of the Ayushman scheme meant for the poor.
A Free Press investigation has found that in Narmadapuram and Jabalpur, several hospitals registered under the scheme are demanding advance payments from Ayushman card holders. Patients in both the districts reported being asked to deposit money before undergoing major procedures. In many cases, the amount is labelled as a “security deposit,” while in Bhopal some hospitals assure that it will be refunded once the Ayushman claim is processed.
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Ayushman Bharat PM-JAY is the world’s largest publicly funded health insurance programme. It provides cashless and paperless treatment up to Rs 5 lakh per family per year to economically vulnerable sections. The scheme covers a wide range of secondary and tertiary treatments, including surgeries, critical illnesses, and hospitalisation.
Narmadapuram: Hospital demanded Rs 15,000 advance payment
At Keshav Hospital in Narmadapuram, a patient, Jitendra Bamne, underwent surgery for a fracture in his leg. He possessed an Ayushman card, and after all procedures and treatment, the card was eventually used. However, before the treatment began, the hospital demanded an advance payment of Rs 15,000. Bamne said, “I even received a message from PM-JAY after the approval stating that my entire treatment would be cashless and I did not have to pay anything, but still I had to pay.”
Jabalpur: Patient paid Rs 1 lakh for treatment
In Jabalpur, Basanti Bai, a 27-year-old vegetable vendor, met with an accident. Her initial treatment was done at a local government hospital, after which she was referred to Smart City Hospital in Jabalpur. The hospital is empanelled under the Ayushman scheme, but when Bai went there for further treatment, her family paid around Rs1 lakh. Bai also said that the surgery was not properly performed and that she is now unable to walk.
Bhopal: Hospitals demand security deposit
In Bhopal, when Free Press reporters visited a few hospitals posing as patients, they were asked to deposit a “security amount.” Hospital staff stated that if the Ayushman claim is approved and all conditions are fulfilled, the amount would be refunded later.
Rules for empanelled hospitals
Eligible beneficiaries can avail treatment at empanelled public and private hospitals across the country by presenting their Ayushman card. The entire cost is supposed to be borne by the government through a pre-authorisation and claim settlement process, ensuring that patients do not pay anything at the point of service. Outpatient department (OPD) services like consultations, minor tests, and medicines without admission are usually not covered, so patients may have to pay.
However, once a patient is admitted (IPD) under an approved package, treatment becomes completely cashless. This includes hospital stay, surgery, medicines, diagnostics, and food. Hospitals must not charge any advance, deposit, or extra fee. Any such demand during hospitalisation is a violation of scheme guidelines.
Cashless On Paper, Cash On The Table! Bhopal Private Hospitals Openly Flouting Cashless Insurance Rules By Demanding Upfront PaymentsMayank Agarwal, Chief Executive Officer in-charge of Ayushman Bharat, said, “As per scheme guidelines, there should be no out of pocket expenditure for beneficiaries, and follow-up calls are made to monitor compliance. However, if a case does not convert into an IPD package, patients may have to pay for diagnostic tests, as OPD services are not covered under the Ayushman scheme. Once admitted under an IPD package, all tests and treatment are covered. Any violation of these rules will be acted upon if specific cases are reported.”