Why is a Samford hospital Ranchi refusing an Ayushman card for patient admission?

Dear SANJAY KUMAR ji,

We understand how stressful this situation can be when your 79-year-old mother is already admitted and her treatment is going on. Since Samford Hospital is an Ayushman-empanelled hospital, you should ask the hospital to clearly explain why her Ayushman Card is not being processed for this particular admission.

Being an empanelled hospital does not mean that every treatment, test or admission is automatically covered. Ayushman Bharat PM-JAY works through specific treatment packages and eligibility rules. The hospital also has to process the appropriate package and, where required, obtain pre-authorisation.

First ask the hospital for the exact reason

Go to the hospital's Ayushman Mitra/PM-JAY desk and ask:

• Why is my mother's Ayushman Card not being accepted?

• Is her current treatment covered under an applicable PM-JAY package?

• Is the admission registered under an eligible package?

• Is pre-authorisation required?

• Has a pre-authorisation request been submitted?

• If it was rejected, what is the exact rejection reason?

• Is there any problem with her Ayushman Card or beneficiary verification?

• Is the issue related to the Nephrology specialty or the particular treatment being provided?

High sugar and Nephrology treatment need package verification

High blood sugar by itself does not mean that the entire hospital admission will automatically be covered under PM-JAY.

Your mother's actual diagnosis, reason for hospitalisation and treatment being provided need to be matched with the applicable PM-JAY package.

For example, if she is receiving treatment for a kidney-related complication, acute kidney problem, dialysis or another covered condition, the hospital should check the relevant package rather than simply refusing the Ayushman Card.

The hospital's current website confirms that Samford has Nephrology services and also lists kidney and dialysis care among its services.

What you should do if the hospital is refusing cashless treatment

1. Ask for the Ayushman Mitra/PM-JAY desk.

2. Show your mother's Ayushman Card and valid ID.

3. Ask them to verify her beneficiary status.

4. Ask them to identify the applicable treatment package.

5. Ask whether pre-authorisation has been submitted.

6. If rejected, ask for the exact rejection reason.

7. Ask whether the problem is related to documentation, package availability, specialty, eligibility or the PM-JAY portal.

8. Keep copies of all documents, bills and written communication

Important point about the hospital's Ayushman status

An Ayushman-empanelled hospital is required to follow the applicable PM-JAY rules for covered packages, but empanelment alone does not guarantee that every admission or every service is covered.

Documents you should keep ready

• Ayushman Card

• Aadhaar card/valid government ID

• Admission papers

• Doctor's prescription and diagnosis

• Nephrology consultation notes

• Blood sugar reports

• Kidney function tests such as creatinine/urea

• Urine reports

• Ultrasound/CT or other kidney reports, if available

• Dialysis records, if dialysis is being done

• Previous medical records

• Previous discharge papers

• Current medicine list

• Hospital bills and payment receipts

Most importantly, do not delay your mother's medical treatment while the insurance issue is being resolved. Continue discussing her medical care with the treating doctor while simultaneously asking the Ayushman desk and PM-JAY helpline to clarify the coverage issue.

Samford is “legally required to provide cashless treatment for every condition” simply because it is empanelled. The safer and more accurate wording is that covered PM-JAY packages for eligible beneficiaries should be processed according to scheme rules, while the exact diagnosis, package, eligibility and pre-authorisation requirements must be checked.

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