What Should You Do If a Hospital Says Ayushman Package Is Not Available?

Dear Vijay Gupta ji,

If a hospital says that a treatment package is not available, do not immediately agree to pay the full amount without understanding the reason. The next steps depend on whether you are already admitted or planning treatment.

First, ask the hospital for a clear explanation about why the package is unavailable and whether the treatment can be covered under Ayushman Bharat (PM-JAY), insurance, or any other health scheme.

If the Patient is Already Admitted

If the patient is admitted and the hospital refuses the package, you can take the following steps

• Ask for a Detailed Cost Estimate: Request a written breakup of all charges, including surgery fees, room charges, medicines, investigations, implants, and other expenses.

• Contact the Ayushman Help Desk: If you are using an Ayushman Card, visit the hospital's Ayushman Mitra desk and ask whether the required procedure is covered under any available PM-JAY package.

• Speak with the Hospital Billing Department: Ask them why the package is not available and whether an alternative approved package can be used.

• Keep All Documents Safe: Maintain copies of medical reports, prescriptions, admission papers, bills, and any communication with the hospital.

If the Surgery or Treatment is Planned for Future

Before admission, you should

• Ask the hospital to confirm package availability in writing.

• Verify whether the hospital is currently active under the required scheme.

• Check if another empanelled hospital provides the same treatment under the available package.

• Compare treatment options before finalising the hospital.

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

Online Verification

You can verify hospital empanelment through the official PM-JAY hospital search portal:

• Select your:

  • State

  • District

  • Hospital name (if available)

  • Specialty (if required)

• Check whether the hospital is listed as PM-JAY empanelled.

If the Hospital Still Refuses the Package

You can follow this escalation process

Hospital Ayushman Desk → Hospital Grievance Department → State Health Agency (SHA) → PM-JAY Helpline

You can

• Submit a written complaint to the hospital's grievance department.

• Contact the Ayushman Bharat helpline 14555 for scheme-related assistance.

• Keep all bills and documents if you need to raise a formal complaint.

Our Suggestion

Before taking admission or paying any large amount, always confirm these three things with the hospital

• Is the hospital currently accepting Ayushman Bharat benefits?

• Is my required surgery or treatment covered under the PM-JAY package?

• Will there be any additional charges that I need to pay?

Do not depend only on verbal information from the counter. Always ask for proper confirmation from the Ayushman Help Desk or billing department to avoid unexpected expenses.

How HexaHealth Can Assist You

• Ayushman Bharat Guidance: We help you understand your PM-JAY eligibility and explain the coverage process.

• Hospital Verification Support: We help you check suitable hospitals and understand whether they provide the required treatment under Ayushman Bharat.

• Treatment Guidance: We explain the treatment process, documents required, and next steps before admission.

• Hospital Selection: We help you connect with suitable HexaHealth partner hospitals based on your medical condition and location.

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

Please share

• Hospital name and city

• Treatment or surgery required

• Whether the patient is already admitted or planning admission

• Whether you have an Ayushman Card, insurance, or are paying privately

We can guide you with the next steps accordingly.

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