Can a Hospital Charge Money Even If You Have an Ayushman Card?

Dear Uday Kumar ji

Hospitals empanelled under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) are expected to provide cashless treatment for eligible medical conditions and approved treatment packages. If a hospital asks you to pay despite having a valid Ayushman Card, first understand the reason for the charges, as some services or non-covered treatments may not be included under the scheme.

If you believe the charges are incorrect, you should immediately contact the hospital's Ayushman Help Desk (Ayushman Mitra) for clarification.

Why Might a Hospital Ask for Money?

Some possible reasons include

• The treatment is not covered under the PM-JAY package.

• The hospital has not yet received pre-authorisation approval.

• Your eligibility or documents could not be verified.

• You requested additional services or facilities that are not included in the approved package.

• There may be an administrative or technical issue during claim processing.

Always ask the hospital to explain the reason before making any payment.

What Should You Do?

Speak to the Ayushman Help Desk

Instead of discussing only with the billing counter

• Visit the hospital's Ayushman Mitra Help Desk.

• Ask whether your treatment is covered under PM-JAY.

• Request a written explanation if any payment is being asked.

Keep All Documents Safe

Maintain copies of

• Ayushman Card

• Aadhaar Card

• Doctor's prescription

• Medical reports

• Hospital bills and payment receipts (if any)

• Any written communication provided by the hospital

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

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

Online Verification

• Visit the PM-JAY Hospital Finder.

• Select:

  • State

  • District

  • Hospital Name (or Specialty, if required)

• Click Search to view the hospital details.

• Confirm that the hospital is PM-JAY empanelled.

Our Suggestion

Before getting admitted, always confirm these four things

• Whether the hospital is currently PM-JAY empanelled.

• Whether your treatment or surgery is covered under the scheme.

• Whether the hospital has completed the pre-authorisation process.

• Whether there will be any charges for services that are not included in the approved PM-JAY package.

Taking these steps in advance can help avoid confusion during admission and treatment.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand your PM-JAY eligibility, coverage, and cashless treatment process.

• Hospital Selection: We help you find PM-JAY empanelled and HexaHealth partner hospitals based on your treatment needs.

• Treatment Coverage Guidance: We explain whether your surgery or treatment may be covered under the approved PM-JAY package.

• Documentation Support: We guide you on the documents required for verification and cashless admission.

• Hospital Coordination: We help you understand the admission process and connect you with the appropriate hospital team.

• Appointment Assistance: We help coordinate consultations with experienced doctors and support you throughout your treatment journey.

Please share the hospital name, city, and the treatment or surgery for which the hospital is asking for payment. We can help you understand whether the charges are appropriate and guide you on the next steps.

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