My father was treated at an empanelled hospital, but due to some confusion, they didn’t use his Ayushman card, and we had to pay the entire bill in cash. Is there a process to submit these bills to the government and get our money reimbursed?
This is a very important point of clarification: the Ayushman Bharat (PM-JAY) scheme is cashless only and does not have a process for patient reimbursement. If an empanelled hospital has wrongly charged you for a covered treatment, you cannot claim the money back from the government. Your only recourse is to file a formal grievance against the hospital to get a refund from them.
The ‘Cashless Only’ Principle of Ayushman Bharat
I was discussing this specific scenario with a public health official. He was very clear that PM-JAY is not a reimbursement-style insurance. The entire system is designed to be cashless at the point of service to ensure beneficiaries never have to arrange for funds. Beneficiaries are not meant to pay first and get the money back from the government later.
What to Do If You Were Wrongly Charged by a Hospital
My friend unfortunately went through this exact situation. The hospital made him pay the full bill for a covered surgery, giving an excuse that their system was down. The health official’s advice to him was to immediately file a formal grievance against the hospital. To do this, he first had to gather all his documents: the final hospital bill, all the payment receipts, the patient’s discharge summary, and his father’s Ayushman card details.
The Process of Filing a Grievance for a Refund
With all the documents ready, my friend called the Ayushman Bharat national helpline (14555) and explained the situation in detail. The operator registered a formal complaint against the hospital for violating the scheme’s cashless mandate. He also advised my friend to upload copies of all the bills and receipts to the online grievance portal (CGRMS) to create a strong, documented case.
How the Grievance Process Leads to a Refund
The official explained that once a grievance is filed with proof, the National Health Authority investigates the matter. If the hospital is found to be at fault for wrongly charging the beneficiary, they are instructed by the authorities to refund the entire amount they collected from the patient. My friend confirmed that after the government’s intervention, the hospital contacted him and processed a full refund.
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