Why Is the PM-JAY Card Not Being Accepted for Multiple Myeloma Treatment?

Dear Rosamma samuel ji,

Yes, treatment for multiple myeloma is covered under Ayushman Bharat PM-JAY.

How to Check Ayushman empanelled hospital?

1. Visit the official Ayushman Bharat PM-JAY hospital search portal.
2. Select your state.
3. Select your district.
4. View the overall list of PM-JAY empanelled hospitals in your district.
5. Select Government or Private hospital, as applicable.
6. Choose the relevant specialty for your treatment from the available options.
7. Enter or select the exact hospital name.
8. Enter the captcha code displayed on the screen.
9. Click on Search to view the results.
10. Check whether the hospital's empanelment is active and whether the relevant specialty and treatment package are available. The hospital's Ayushman help desk can provide details about package availability and the pre-authorisation process for multiple myeloma treatment.

Why might a hospital refuse or delay accepting the Ayushman card?

Private hospitals may refuse or delay cashless treatment under PM-JAY for financial, administrative, technical, or treatment-related reasons. Although eligible patients are entitled to cashless treatment for approved packages at appropriately empanelled hospitals, practical barriers can sometimes affect access to care.

1. Financial and reimbursement obstacles can affect hospitals.

• Delayed government payments: Delays in processing and settling claims may affect a hospital's day-to-day cash flow.
• Low package rates: Some hospitals may consider government-fixed treatment rates insufficient to cover specialist fees, medicines, equipment, and other treatment expenses.
• Claim rejections: Pre-authorisation refusals or rejected claims can create financial concerns for hospitals.

2. Administrative and infrastructure issues can cause delays.

• Empanelment requirements: Hospitals must meet the scheme's requirements and maintain valid empanelment for the relevant services.
• Technical problems: Portal errors, server downtime, and difficulties processing patient details or claims may delay treatment approval.
• Documentation requirements: Missing medical reports or incomplete records may delay the pre-authorisation process.

3. The hospital's specialty and treatment package matter.

• Specialty not covered by the hospital's empanelment: A hospital may participate in PM-JAY but may not be empanelled for the specialty or treatment you require or the hospital is not empanelled under PMJAY.
• Package approval: The hospital must check whether the required multiple myeloma treatment is included in an applicable package and whether pre-authorisation is required.

Which documents should you carry?

• Ayushman Bharat PM-JAY card or beneficiary identification details.
• Aadhaar card or another accepted identity document.
• Multiple myeloma diagnosis reports, including bone marrow biopsy results, if available.
• Recent blood tests, imaging reports, and other relevant investigation reports.
• Oncologist's or haematologist's prescription and treatment plan.
• Previous hospital records, discharge summaries, and treatment papers.
• Details of ongoing or previous treatment, including chemotherapy and medicines, where applicable.

Carry the original documents along with photocopies or digital copies. Additional documents may be required depending on the treatment package.

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