Can Medical Expenses Be Reimbursed Under PM-JAY After Treatment at a Non-Empanelled Hospital?

Hello,

Aapki aunty ki tabiyat kharab hone par aap unhe Malout se Bathinda ke Pulse Hospital lekar gaye aur lagbhag ₹1 lakh ka bill pay kiya. Aapka Ayushman card hospital mein accept nahi hua, isliye aap bill ka paisa wapas paane ke baare mein pooch rahe hain.

Ayushman Bharat PM-JAY ek cashless treatment scheme hai. Ismein aam taur par patient ko pehle kisi non-empanelled private hospital mein treatment karwane ke baad bill submit karke reimbursement nahi milta. Cashless treatment ke liye patient eligible hona chahiye, hospital PM-JAY ke under empanelled hona chahiye aur treatment approved package ke under aana chahiye.

Isliye Pulse Hospital mein kiye gaye treatment ka lagbhag ₹1 lakh ka bill Ayushman card se wapas milna guaranteed nahi hai. Lekin aap apne case ki jaanch karwane aur written clarification lene ke liye neeche diye gaye steps follow kar sakte hain.

Punjab State Health Agency se sampark karein

Aap Punjab State Health Agency (SHA) se written mein pooch sakte hain ki aapki aunty ke emergency treatment ke case mein koi applicable provision ya doosri government health scheme ke tahat madad mil sakti hai ya nahi.

• Patient ki emergency condition aur hospital mein admission ki details batayein.
• Yeh explain karein ki Pulse Hospital mein Ayushman card accept nahi kiya gaya aur aapne lagbhag ₹1 lakh khud pay kiye.
• Hospital ka naam, admission date, discharge date aur treatment details application mein likhein.
• Authority se written response maangein ki reimbursement ya kisi financial assistance ka koi provision is case mein applicable hai ya nahi.

Important: Sirf emergency certificate ya application dene se PM-JAY reimbursement automatically approve nahi hota. Final decision applicable scheme rules aur authority ki jaanch par depend karega.

PM-JAY grievance portal par complaint raise karein

1. Official PM-JAY grievance portal kholein: PM-JAY Central Grievance Redressal Management System.
2. Portal par available instructions ke according grievance register karein.
3. Patient ki Ayushman card details aur hospital ki information fill karein.
4. Clearly likhein ki patient ko breathing problem ke kaaran Pulse Hospital, Bathinda mein treatment ke liye le jaya gaya tha aur hospital ne Ayushman card accept nahi kiya.
5. Available bills, payment receipts aur medical records attach karein.
6. Grievance number save karein, taaki aap complaint ka status check kar sakein.

Grievance portal par complaint karne se aapke case ki jaanch ya clarification mil sakti hai, lekin ise reimbursement ki guarantee na samjhein.

Kaun se documents ready rakhein?

• Patient ka Ayushman Bharat PM-JAY card.
• Patient ka Aadhaar card ya valid photo ID.
• Pulse Hospital ki original discharge summary.
• Hospital ke item-wise bills aur lagbhag ₹1 lakh ki payment receipts.
• Admission papers aur doctor ki prescriptions.
• Blood tests, X-ray, CT scan ya doosri investigation reports, agar hui hain.
• Emergency ya admission ke samay ki medical notes aur certificate, agar hospital provide kare.
• Patient ke bank account ki details, agar authority application ke liye maange.
• Grievance number aur authority ke saath hui correspondence, agar available ho.

Aapke case mein ab kya karna chahiye?

1. Pulse Hospital se complete discharge summary, item-wise bill, payment receipts aur emergency treatment records lein.
2. Hospital se written mein poochhein ki treatment ke samay hospital PM-JAY ke under empanelled tha ya nahi.
3. Punjab State Health Agency aur PM-JAY grievance portal par apni written request submit karein.
4. Authority se written confirmation lein ki aapke case mein reimbursement ya kisi doosri financial assistance ka provision hai ya nahi.

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