What to Do If Ayushman Bharat Claim Is Rejected?

Dear Anees Grewal ji,

If your Ayushman Bharat (PM-JAY) claim is rejected or the hospital denies cashless treatment, do not panic. First, understand the exact reason for rejection and follow the proper grievance process. A claim may be rejected due to reasons such as treatment not being covered under the PM-JAY package, eligibility issues, document mismatch, incomplete verification, or hospital-related approval issues.

The first step is to ask the hospital for the specific reason for rejection and check whether the issue can be resolved through correction or re-verification.

Steps to Take After Ayushman Claim Rejection

1. Contact the Hospital Ayushman Help Desk

• Visit the hospital's Ayushman Mitra desk instead of only discussing the issue with the billing counter.

• Ask for the written reason for rejection or clarification about why the treatment was not approved.

• Confirm whether the required treatment or surgery is covered under the PM-JAY package.

• Keep copies of all medical documents, prescriptions, reports, and hospital communication.

2. Check the Reason Behind the Rejection

Common reasons for Ayushman claim rejection may include

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

• The patient’s eligibility details are not verified.

• Required documents are missing.

• Hospital has not completed the pre-authorisation process properly.

• The procedure details submitted by the hospital do not match the approved package.

Understanding the exact reason helps in taking the correct next step.

3. Raise a Complaint with Ayushman Bharat Support

If the issue is not resolved by the hospital, you can register a grievance through:

• Ayushman Bharat PM-JAY Helpline: 14555

• State Ayushman Bharat helpline number (as applicable).

• PM-JAY grievance redressal system.

While raising a complaint, keep ready:

• Ayushman Card details.

• Aadhaar Card or ID proof.

• Hospital name and details.

• Medical documents.

• Rejection details or bills (if any).

4. Do Not Pay Without Proper Information

If the hospital asks you to pay for treatment despite having an Ayushman Card

• Ask for a proper written explanation.

• Request an itemised bill with all charges mentioned.

• Keep all payment receipts and documents for future grievance filing.

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

Before taking admission, it is better to confirm whether the hospital is empanelled under PM-JAY.

Online Verification

• Visit the official PM-JAY Hospital Finder.

• Select:

  • State

  • District

  • Hospital Name (or specialty, if required)

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

Our Suggestion

Before admission or surgery, always confirm these points

• Is the hospital currently active under the Ayushman Bharat scheme?

• Is your required surgery or treatment covered under PM-JAY?

• Has the hospital started the pre-authorisation process?

• Are all your documents verified?

Many claim-related problems can be avoided by confirming coverage and completing verification before hospital admission.

How HexaHealth Can Assist You

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

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

• Treatment Coverage Guidance: We help you understand whether your required surgery or procedure may come under the Ayushman package.

• Documentation Support: We guide you about the documents required for hospital admission and claim processing.

• Hospital Coordination: We help connect you with hospital teams and experienced doctors for further assistance.

• Appointment Assistance: We help coordinate consultations and treatment-related appointments.

Please share:

• The hospital name and city where your claim was rejected.

• The treatment or surgery required.

We can guide you on the possible next steps and help you connect with the right hospital support team.

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