How to Resolve a Rejected PM-JAY Cancer Treatment Claim?

Dear Ashwin Mehta ji

If your Ayushman Bharat (PM-JAY) cancer treatment claim has been rejected, don't panic. In many cases, claims are rejected due to document errors, incomplete medical records, eligibility verification issues, or incorrect package selection. Most of these issues can be resolved by working with the hospital and following the official PM-JAY grievance process.

Cancer treatment often involves chemotherapy, radiation therapy, surgery, or multiple hospital visits. Before beginning treatment, ask the hospital to confirm that your treatment package has been approved under PM-JAY. If your claim is rejected, request the reason in writing and seek clarification immediately. Many issues can be resolved quickly by correcting documents or resubmitting the pre-authorisation request.

If the hospital asks you to pay despite having a valid Ayushman Card, keep all bills and receipts safely. They can be useful while filing a grievance or requesting reimbursement, if applicable

Common Reasons for Claim Rejection

Your cancer treatment claim be rejected because of

• Incomplete or incorrect medical documents.

• Incorrect PM-JAY treatment package selected by the hospital.

• Missing biopsy, pathology, or diagnostic reports.

• Aadhaar or beneficiary details not matching PM-JAY records.

• Pending or rejected pre-authorisation request.

• Treatment not covered under the approved PM-JAY package.

• Hospital not being empanelled for the required oncology services.

Step 1: Contact the Hospital's Ayushman Help Desk

Visit the Ayushman Mitra Help Desk or speak to the hospital's PM-JAY Nodal Officer.

Request :

• The exact reason for claim rejection.

• A written copy of the rejection, if possible.

• Details of the rejected pre-authorisation request.

• Whether additional documents or medical reports are required.

Many claim issues can be resolved after correcting documents and resubmitting the request.

Step 2: Keep All Medical Documents Ready

Maintain copies of

• Ayushman Card.

• Aadhaar Card.

• Doctor's prescription.

• Biopsy and pathology reports.

• Diagnostic reports (CT, MRI, PET Scan, etc.).

• Hospital admission papers.

• Discharge summary (if available).

• Bills and payment receipts (if you had to pay).

These documents will help if you need to file a grievance.

Step 3: Register an Official Complaint

If the hospital is unable to resolve the issue

• Call the PM-JAY National Helpline 14555.

• Explain your situation and register a complaint.

• Note your complaint or grievance number for future tracking.

You can also file a complaint through the PM-JAY Centralized Grievance Redressal Management System (CGRMS) by submitting your treatment details and supporting documents.

How to Check Whether the Hospital Accepts Ayushman Bharat (PM-JAY)?

Before starting treatment, verify whether the hospital is empanelled under PM-JAY.

Online Verification

• Visit the PM-JAY Hospital Finder.

• Select:

  • State

  • District

  • Hospital Name (or Oncology specialty).

• Click Search.

• Confirm that the hospital is PM-JAY empanelled.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand PM-JAY claim procedures, eligibility, and cancer treatment coverage.

• Claim Support Guidance: We explain common reasons for claim rejection and guide you on the next steps.

• Hospital Selection: We help you find PM-JAY empanelled and HexaHealth partner cancer hospitals near your location.

• Documentation Guidance: We help you understand the documents required for claim verification and pre-authorisation.

• Treatment Guidance: We explain chemotherapy, radiation therapy, cancer surgery, and other available treatment options.

• Appointment Assistance: We help connect you with experienced oncologists and coordinate consultations and treatment planning.

Wishing you and your family good health always.
Warm regards,
Team HexaHealth