What to Do If a Hospital Refuses Your Ayushman Bharat Card
It is illegal for a PMJAY empanelled hospital to refuse treatment to a valid Ayushman Bharat cardholder for a covered treatment. Yet, some patients face this situation — hospitals citing various reasons to turn away PMJAY patients or demand cash payments. This guide tells you exactly what to do.
Know Your Rights
Under the PM-JAY scheme guidelines, every empanelled hospital is bound to provide cashless treatment to eligible beneficiaries. The hospital cannot refuse admission if your PM-JAY card is valid, the treatment is covered under the scheme, and you are within your ₹5 lakh annual limit. The hospital cannot demand advance deposits, ask for partial cash payments, or redirect you to non-PMJAY channels for covered treatments.
Common Reasons Hospitals Give for Refusal
“Your card is not valid”: Ask the Ayushman Mitra to verify your card through the PM-JAY portal. If your card is genuine and you are eligible, the system will confirm it. If there is a technical glitch, call 14555 for real-time support.
“We don’t accept PMJAY anymore”: Check the hospital’s current empanelment status on the PMJAY website or through 14555. If the hospital is still listed as empanelled, it cannot refuse.
“This treatment is not covered”: Ask the hospital to specify which treatment they say is not covered. Cross-check against the PM-JAY package list available on the official website. Many hospitals wrongly claim that certain treatments are not covered.
“No beds available for PMJAY patients”: Hospitals cannot discriminate between PMJAY and paying patients for bed allocation. If they have beds available for paying patients but claim no beds for PMJAY patients, this is a violation.
Step-by-Step Complaint Process
Step 1 — Document everything: Note the hospital name, date, time, name of the person who refused, and the exact reason given. If possible, record the conversation (where legally permitted) or get the refusal in writing.
Step 2 — Call 14555 immediately: Report the refusal while you are still at the hospital. The helpline operator can sometimes resolve the issue in real-time by calling the hospital’s PMJAY nodal officer.
Step 3 — File a formal complaint: Through the Ayushman Bharat app or through 14555, file a formal grievance with your complaint reference number.
Step 4 — Escalate if needed: If 14555 does not resolve the issue, contact your district’s Chief Medical Officer (CMO), the State Health Agency, or the District Collector’s office. PMJAY refusal by empanelled hospitals is a serious compliance violation.
Step 5 — Seek alternative hospital: While your complaint is being processed, find another empanelled hospital for your treatment. Use PMJAYHospitals.com to search for alternative hospitals in your district that offer the same specialty.
What Happens to Hospitals That Refuse
Hospitals found violating PMJAY norms face serious consequences including monetary penalties, suspension of empanelment, permanent de-empanelment, and blacklisting. The National Health Authority regularly audits hospitals and acts on patient complaints.
Prevention Tips
- Always call the hospital before visiting to confirm they are accepting PMJAY patients
- Carry all documents (Ayushman card, Aadhaar, medical reports)
- Go directly to the Ayushman Mitra desk, not the general reception
- Keep 14555 saved in your phone
- Know your coverage — check your remaining balance before going to the hospital
Disclaimer: PMJAYHospitals.com is an independent directory and is not affiliated with the National Health Authority or any government body. For official information, visit pmjay.gov.in or call 14555.