No Denial of AB-PMJAY Treatment: Odisha Health Minister warns Private Hospitals

Bhubaneswar: Two weeks after the launch of Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) and the state-run Gopabandhu Jan Arogya Yojana (GJAY) in Odisha, private hospitals empanelled under the scheme have reportedly refused to provide free treatment for certain procedures, citing low package rates and technical issues. 

On Tuesday, Odisha Health and Family Welfare Minister Mukesh Mahaling issued a stern warning to all empanelled hospitals, saying strict action will be taken against any hospital that denies treatment to eligible patients.

The confusion comes just days after several private hospitals raised concerns over the financial viability of the newly implemented schemes. According to the All Odisha Private Medical Establishments Forum (AOPMEF), the revised treatment package rates are 15-20% lower than the earlier Biju Swasthya Kalyan Yojana (BSKY), making it difficult for hospitals to cover costs and maintain quality.

Also read- Union Health Minister JP Nadda launches Ayushman Bharat scheme in Odisha

Forum secretary Dr Indramani Jena said, "Pricing for implants, including Rs 75,000 for pacemakers and Rs 10,000 for spine implants, is unsustainable. While the packages for ortho surgeries, knee replacement and neurological procedures are down by over 15 per cent, Rs 70,300 is being offered for spinal surgery instead of the old rate of Rs 84,000. For a teflon mesh, only Rs 800 allotted for its minimum price of Rs 1,700."

According to a latest media report by TNIE, the forum is demanding a minimum 30% hike in package rates to keep up with inflation and rising operational costs.

Meanwhile, Health Minister Mahaling reassured the public that the government is actively reviewing all issues flagged by the hospitals. “All concerns related to the scheme are being examined and will be resolved soon,” he said, adding that refusing treatment to eligible patients will invite strict legal action, reports Odishabytes. 

Mahaling clarified that individuals under five categories have been included under the Ayushman Bharat scheme. “Those covered under National Food Security Act (NFSA), the State Food Security Scheme (SFSS) and the Antyodaya Anna Yojana (AAY) can avail the benefits. Naveen and ration cards also serve as proof of eligibility,” he said.

The Minister further stated that the government is leveraging digital infrastructure to bridge any gaps. He clarified that the technical bottlenecks in the current system flagged by the hospitals, especially Aadhaar-based OTP authentication related to PAN-India card integration and OTP verification, are being reviewed for active resolution.

On the demands to increase treatment package rates, the minister said, "The matter is also being looked into. The state government is examining feedback from various stakeholders, including patients and hospitals, and verifying the cost of treatment under the scheme in other states to come up with a solution that is acceptable to all."

“e-KYC (electronic Know Your Customer) verification was conducted during ration card drives, and those left out will soon be linked to the health scheme,” he said.

Also read- 24 Nagpur Hospitals found denying AB-PMJAY Treatment: RTI