My father was recently hospitalized, and we have a file of all the medical bills. Is there a process where I can submit these bills to the Ayushman Bharat department to get the money back?
No, you cannot claim medical bills for reimbursement under the Ayushman Bharat (PM-JAY) scheme. The scheme is designed to be completely cashless, which means that for any covered treatment at an empanelled hospital, you should not have to pay the bills in the first place. The claim is handled directly between the hospital and the government.
Understanding the âCashlessâ vs. âReimbursementâ Model
I was explaining the process to my neighbor. Many private health insurance policies have a reimbursement option, where you pay the hospital first and âclaimâ the money back from the insurer later. Ayushman Bharat, however, is a purely cashless scheme. The entire financial transaction is meant to happen directly between the empanelled hospital and the government, with no payment from the patient.
The Hospital Claims the Bills, Not the Patient
My friend, whose mother was recently treated under the scheme, confirmed this from his experience. He said he was never asked to pay or even shown a final bill. The Ayushman Mitra and the hospitalâs billing department managed everything behind the scenes. It was the hospitalâs responsibility to submit the claim and all the supporting bills to the authorities to receive their payment for the treatment provided.
What to Do If You Have Paid the Bills Yourself
My uncle was once in a rare situation where an empanelled hospital wrongly made him pay the bills due to a system error. His path to getting his money back was not to file a âclaimâ with the government, but to file a grievance against the hospital. He called the national helpline (14555), reported the hospital for incorrect billing, and submitted his paid bills as proof. The government then investigated and directed the hospital to refund his money.
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