Unpaid Dues: Aarogyasri-empanelled Hospitals Facing Financial Strain

Private hospitals are considering de-empaneling themselves from the scheme due to the devalued payment by the government. Moreover, dues under the Employee Health Services (EHS) have also not been cleared yet.

The Employee Health Scheme (EHS) is a government-sponsored health scheme that provides cashless medical services to eligible employees, pensioners, and their dependents. The Aarogyasri Healthcare Scheme is a public-private partnership (PPP) that provides cashless healthcare to the below-poverty line (BPL) families in Andhra Pradesh and Telangana.

The Aarogyasri HealthCare Trust's official website states that 327 corporate hospitals are affiliated, with 54 of them being in Hyderabad. However, because of financial difficulties, many hospitals are leaving the program.

According to the Telangana Aarogyasri Network Hospitals Association (TANHA), for more than one year the government has not taken any steps to clear the outstanding dues. In April, they made a representation to the health minister, who promised to pay them all promptly.

Vaddiraju Rakesh, president of TANHA, told The New Indian Express, “Private hospitals are willing to extend the Aarogyasri services to beneficiaries, but it should not jeopardise their financial viability. For the past decade, we have been urging the government to revise package rates by 7% to account for inflation, as the current rates make it challenging to provide services. We also seek the release of old dues, a redraft of the MoU, and adjustments to miscellaneous deductions and cancellations.”

According to the Aarogyasri Memorandum of Understanding, reimbursements must be handled within 40 days of treatment; however, this has not been done, causing major delays, Rakesh continued. Previously, the insurance coverage was Rs 5 lakh but in August, the government extended the coverage to Rs 10 lakh. Moreover, 163 new procedures have been added bringing the total to 1835 under the health scheme.

“If the government plans to implement changes to the scheme, it must communicate with service providers about its intentions and how to effectively implement the proposals. Network hospitals were not invited for any discussions, and we currently lack clarity on the new procedures and enhanced packages. Given the challenging circumstances we are facing, how can we accommodate these changes?” Rakesh added.

Officials from Aarogyasri refuted these allegations, claiming that since the new government assumed power, dues have been paid on a monthly basis. RV Karnan, director of the Aarogyasri Healthcare Trust told the daily that clearing dues for dialysis centres, NIMS, private hospitals, and lastly government hospitals on a priority basis.

“Payments have been cleared up to July, with the remaining dues in process. Since March, up to ₹50 lakh has been paid to private hospitals on a first-in-first-out basis. As for the 163 new procedures, we are initially implementing them in government hospitals and NIMS to bolster government health facilities, with plans to extend these to private hospitals later,” he added.