Can PMJAY hospitals charge extra for a pacemaker device?

Hello,

If Sanjeevani Hospital, Virar is asking you to pay extra for a pacemaker device, it is important to first understand the reason for the additional charge.

Sanjeevani Hospital, Virar is a PM-JAY (Ayushman Bharat) empanelled hospital, and pacemaker implantation is covered under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). Eligible beneficiaries can receive cashless treatment for approved pacemaker implantation packages at PM-JAY empanelled hospitals, subject to eligibility verification and package approval.

What Is Covered Under PM-JAY For Pacemaker Implantation?

The approved PM-JAY cardiac packages generally include :

• Single Chamber Permanent Pacemaker Implantation.

• Dual Chamber Permanent Pacemaker Implantation.

• Biventricular Pacemaker (CRT/CRT-D), where medically indicated.

• Cost of the standard approved pacemaker device.

• Surgeon's and cardiologist's fees.

• Operation theatre charges.

• ICU and hospital stay.

• Medicines and consumables during hospitalization.

• Diagnostic investigations related to the procedure.

• Post-operative care as per the approved package.

Why Might the Hospital Ask for Extra Payment?

An empanelled hospital cannot charge extra for a standard PM-JAY-approved pacemaker package once the treatment has been authorised.

However, additional payment be requested in situations such as :

• You or your treating cardiologist choose a premium or imported pacemaker model that is not covered under the standard PM-JAY package.

• The selected device costs more than the amount approved under the PM-JAY package.

• A medical device or service is requested that falls outside the approved package.

In such cases, the hospital should clearly explain the reason for the additional charge and obtain your consent before proceeding.

What Should You Do?

If you believe you are being asked to pay extra for a treatment that should be covered under PM-JAY:

• Ask the hospital to explain why the additional payment is required.

• Request details of the PM-JAY package approved for your treatment.

• Confirm whether the recommended pacemaker is a standard PM-JAY-covered device or a premium variant.

• Speak to the hospital's Ayushman Mitra/PM-JAY Help Desk for clarification.

How HexaHealth Can Assist You

We can help you:

• Explain the PM-JAY package applicable to pacemaker implantation.

• Help you understand whether the additional charge appears to be for a premium device or another non-covered item.

• Guide you regarding the PM-JAY cashless treatment process and required documents.

• Connect you with a suitable PM-JAY empanelled partner hospital, if required.

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