Can Ayushman Bharat Cardholders Claim Reimbursement for Emergency Surgery at a Non-Empanelled Hospital?

Dear Aravindakshan Menon ji

We understand that your wife suffered a serious injury after falling while sleeping, fractured a bone in her upper leg, and needed urgent surgery at Daya General Hospital, Thrissur. Since a nearby hospital did not accept the Ayushman Bharat card, you admitted her to Daya Hospital and paid the expenses yourself.

You may ask the Ayushman Bharat authorities to review your case, but reimbursement is not guaranteed. Under the usual PM-JAY process, treatment is provided cashless at an empanelled hospital for an approved package. If you paid a non-empanelled private hospital directly, you generally cannot claim the bill back through the standard PM-JAY process. An exception should not be assumed unless the relevant scheme authority confirms that your case qualifies under an applicable rule.

Because the surgery was urgent, please keep all medical records and payment proofs. You can submit a written request to the relevant Ayushman Bharat authority in Kerala and ask whether any exceptional provision or grievance process applies to your case.

What should you do now?

1. Ask whether Daya General Hospital, Thrissur, was empanelled under PM-JAY on the date of admission and whether any reimbursement or exceptional review process applies.
2. Request a complaint or grievance reference number and keep it safe.
3. Submit a written application with the hospital bills, payment receipts and medical records to the relevant scheme authority, following the instructions provided by the helpline.
4. Keep copies of every document and your complaint acknowledgement. Do not hand over your original records without retaining copies.

Documents you should keep ready

• Your Ayushman Bharat card and your wife's card, if available.
• Aadhaar cards or other valid identity documents.
• Hospital admission records and the emergency admission notes.
• Doctor's certificate explaining the fall, fracture and urgency of surgery.
• X-ray, CT scan and other investigation reports.
• Operation notes, discharge summary and follow-up advice.
• Original hospital bills, itemised bills and payment receipts.
• Proof of payment, such as card receipts or bank transaction records.
• Bank account details and any additional documents requested by the scheme authority.

How to check an Ayushman empanelled hospital

1. Open the official PM-JAY hospital search portal.
2. Select Kerala as your state.
3. Select Thrissur district.
4. View the list of empanelled hospitals.
5. Select Government or Private hospital, if the filter is available.
6. Choose the relevant speciality, such as Orthopaedics, if available.
7. Select the hospital name, if the option is available.
8. Enter the captcha code.
9. Click Search.
10. Confirm with the hospital's Ayushman help desk whether it is currently empanelled and whether the required fracture treatment is covered under an approved package.

Wishing your wife a smooth recovery and both of you good health always.
Warm regards,
Team