Do Ayushman Card holders need to pay for dialysis and antibiotics in the hospital?

Hello,

If the patient is admitted to a hospital for a serious infection in the blood and the doctor has advised antibiotics and dialysis, this can be a serious medical condition and should be treated without delay.

If the patient has a valid Ayushman Bharat PM-JAY card, treatmentbe available cashlessly at a currently empanelled PM-JAY hospital, provided the required treatment is covered under an approved package. PM-JAY covers eligible secondary and tertiary hospitalisation, including medical treatment, medicines and consumables, diagnostic investigations, ICU/non-ICU care and other package-related expenses.

Dialysis is also covered under applicable PM-JAY packages for eligible beneficiaries.

Can the Hospital Ask for Money?

No empanelled hospital can demand money from a valid Ayushman Card holder for treatment that is covered under the applicable PM-JAY package.

However, you should first confirm exactly what the hospital is asking money for. Some services may fall outside an approved package, and coverage can also depend on the patient's eligibility, available package and applicable state-specific rules.

For covered treatment, PM-JAY is designed as a cashless scheme, with the approved amount paid to the hospital rather than reimbursed to the patient. Official PM-JAY information states that empanelled hospitals cannot charge beneficiaries for treatment covered within the applicable benefit.

What Should You Do If the Hospital Is Asking for Money?

If the patient is already admitted, do not delay necessary treatment.

Ask the hospital's Ayushman Mitra/help desk:

1. Is the patient registered under PM-JAY?

2. Has the Ayushman package been approved?

3. What exact treatment or service is being charged?

4. Is the charge included in the approved package?

5. Is any pre-authorisation pending?

6. If payment is required, ask for a written explanation and receipt.

How to Check Whether the Hospital Is PM-JAY Empanelled

Before admission or, if already admitted, as soon as possible :

1. Open the official PM-JAY hospital search portal.

2. Select the patient's State.

3. Select the District.

4. Search the exact hospital name.

5. Check its current PM-JAY empanelment.

6. Check whether the hospital has the relevant speciality, such as Nephrology/Dialysis.

Documents to Keep Ready

Take these documents to the Ayushman desk :

• Ayushman Bharat/PM-JAY card

• Aadhaar card or valid identity proof

• Doctor's prescription

• Admission papers

• Blood test reports

• Kidney function and other investigation reports

• Dialysis prescription, if already advised

• Previous dialysis records, if applicable

• Previous discharge summary and medical records

• Current medicines list

• Any previous CT, ultrasound or other reports

If the patient is already admitted, ask the hospital Ayushman desk to verify the card and eligibility immediately.

Important for Blood Infection and Dialysis

A blood infection can become serious, particularly when the patient has kidney problems or requires dialysis. Antibiotics and dialysis should not be delayed because of uncertainty about payment.

The treating doctor should decide the appropriate antibiotic, dialysis schedule and other treatment based on the patient's condition and test results. Do not stop antibiotics or dialysis without medical advice.

How HexaHealth Can Help

We can help you identify suitable PM-JAY empanelled hospitals and doctors, coordinate consultations, and guide you regarding Ayushman verification, documentation and treatment coordination.

Please share the hospital name, city and state where the patient is currently admitted, and tell us what amount the hospital is asking for and what they say the payment is for. We can then guide you on what you should verify with the Ayushman desk.

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