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Ayushman Bharat Scheme: 609 Private Hospitals Opted Out due to Payment Delays, Low Reimbursements since 2018, Says Govt
Moneylife Digital Team 04 April 2025
Life
As many as 609 private hospitals have decided to voluntarily opt out of the Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), citing various reasons, including delays in settlement of claims and low package rates, the Union government says. Gujarat tops the list with 233 private hospitals opting out of the AB-PMJAY scheme, followed by Kerala at 146 and Maharashtra at 83.
 
Replying to a question in Rajya Sabha, Prataprao Jadhav, minister of state in the ministry of health and family welfare said, “The reasons for which hospitals have voluntarily opted out of the scheme include empanelment only for the COVID period, hospitals were closed or non-functional, changes in hospital entity, the hospital relocated, ongoing reconstruction or renovation in the hospital, shortage of supporting or nursing staff, unavailability of specialist doctors, voluntary withdrawal from the scheme, package rates, opting out due to certain treatment packages reserved for public hospitals only (Chhattisgarh and Gujarat), and no referral from public hospitals (Karnataka).”
 
 
Priyanka Chaturvedi, member of Parliament (MP), had asked for information about the amount pending for hospitals under the AB-PMJAY services for both private and government hospitals. She also asked for the number of hospitals that have opted out of the scheme, state-wise and year-wise, since 2019 and with reasons, including pending dues.
 
Without sharing any financial details, Mr Jadhav, the minister of state, merely stated that settlement of claims is an ongoing process and under AB-PMJAY, claims are settled by respective state health agencies (SHA). “The national health authority (NHA) has laid down guidelines for payment of claim to hospitals within 15 days of claims submission for the intra-state hospitals (hospitals located within state) and within 30 days in case of portability claims (hospitals located outside state). Claims are required to be settled within the timeline specified under the scheme.” 
 
“Notable improvements have been recorded in the overall average turnaround time (TAT) for claim settlements year on year. Regular review meetings are organised to take stock of the progress with regard to the claims. Further, capacity building activities are organised for efficient claims settlement,” he added.
 
Separately, Congress president Mallikarjun Kharge had asked for information about the implementation and monitoring of the Ayushman Bharat scheme. In his reply, the minister said, as of 28 February 2025, the number of empanelled hospitals under PM-JAY is 30,957, while the total operational ayushman arogya mandir (AAM) is 176,573. 
 
“The Union government provides approval for the proposals in the form of record of  Proceedings (RoPs) as per norms and available resources. However, the primary responsibility for engagement and availability of human resources in public health facilities lies with the respective state government,” Mr Jadhav says.
 
Data provided by the minister shows that the number of community health officer (CHO) posts vacant in AAM- sub-health centres in rural areas in various states and Union territories (UTs), as of 28 February 2025, was 12,491.
Comments
gkpatham1950
2 weeks ago
Either due to the delay in payment settlement or low reimbursement package, wouldn't be the reason for the union Government, while considering a patient with a PM Ahusman health insurance card standing at the counter of a hospital in the list for his ahead treatment . Is it fare for the Central Government?
Reply
kcrampuria
2 weeks ago
I need services of empenelled hospital in tirupati district
Reply
kcrampuria
2 weeks ago
I need services of empenelled hospital in tirupati district
Reply
kcrampuria
2 weeks ago
What is the use of PMJAY scheme if the encashments of hospital expences are not cleared promptly by centre/state governments.Prime minister must look into it as it is hisflagshiop scheme.
Reply
gkpatham1950
2 weeks ago
In Tamilnadu , I could see in the net a familiar Hospital Vadapalani in Chennai , is in the list of Aushman PM insurance scheme availability. But one person has complaint in the net , after meeting the CMO ,regarding the availability of Aushman PM health insurance scheme, that the hospital does not have such facility he replied. I want to know the names of hospitals having the availability of Aushman PM health insurance scheme . It is better to have the list in advance instead of the neck of the hour.
Reply
karan.r.gandhi
3 weeks ago
Where can I find the list of private hospitals in Mumbai that are empaneled under the Ayushman Bharat Scheme?
Reply
karan.r.gandhi
3 weeks ago
Where can I find the list of private hospitals in Mumbai that are empaneled under the Ayushman Bharat Scheme?
Reply
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