I went to an empanelled private hospital for a covered treatment, but they are denying the cashless service and asking for money. What is the step-by-step process to file a complaint against the hospital?
If an empanelled hospital denies you cashless treatment under Ayushman Bharat, it is a serious violation of their agreement with the government. You should not have to pay for covered procedures, and there are several immediate and effective channels available for you to file a complaint and seek a quick resolution.
The First Step: Contact the Hospital’s Ayushman Mitra
My friend faced this exact problem last month at a private hospital. The first thing I advised him to do was to locate the hospital’s dedicated Ayushman Mitra help desk. He calmly explained the situation to the Mitra, whose primary responsibility is to resolve such issues and facilitate the cashless process for beneficiaries. This should always be your immediate first step to resolve the matter internally.
The Most Effective Step: Calling the National Helpline
In my friend’s situation, the hospital staff was still being uncooperative. The next and most powerful step he took was to immediately call the Ayushman Bharat toll-free helpline at 14555. He provided the helpline operator with his PMJAY ID number and the full name and address of the hospital that was denying treatment.
How Filing a Complaint with the Helpline Works
My friend was impressed by how quickly this worked. The helpline operator immediately registered a formal grievance against the hospital in their system. This triggered an alert to the district-level authorities, who then contacted the hospital’s senior management. Within an hour, the hospital manager personally called my friend, apologized for the “misunderstanding,” and instructed the staff to proceed with the cashless admission.
An Alternative: Filing a Grievance on the Online Portal
I also showed my friend another way to create a formal record of the issue. This is through the official Centralized Grievance Redressal Management System (CGRMS) portal for PM-JAY. It is a website where you can log in, file a detailed written complaint about the hospital’s conduct, and upload any evidence. You receive a unique ticket number, which you can use to track the status of your complaint online.
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