Can you Avail Cashless Treatment under Ayushman Bharat Scheme?

RSBY was replaced with AB-PMJAY by the Modi government in 2018. PMJAY covers more than 1,000 medical procedures and therapies for which the beneficiary can avail the treatment at any of the empaneled hospitals within India. The scheme follows a prospective payment mechanism in which the maximum treatment cost or the coverage amount is pre-determined.

The empanelled hospitals under the PMJAY scheme have to provide cashless treatment to the beneficiaries of the scheme. Upon hospital admission, the beneficiary gets registered under the scheme. During the procedure, assistance is provided by an ‘Aarogyamitra’.

Based on the diagnostic tests and planned medical procedures, the hospital seeks authorization from the society managing Ayushman Bharat Yojana. The hospital then applies for reimbursement after the patient is discharged from the hospital. The entire cost of treatment has to be within the determined ‘package’ cost.

At first, the private hospitals were hesitant to enroll themselves in such a lower package scheme. When the cost was revised by the government, a few private hospitals were approved to be a part of the Ayushman Yojana. As many as 24,653 hospitals (Public: Private = 54:46) have enrolled with the scheme, as per a recent statement issued by the health ministry.

Union Health Minister, Harsh Vardhan said in a statement that over 1.4 Crore Indians have benefitted from cashless treatments under Pradhan Mantri Ayushman Bharat Yojana (PMJAY). According to the statement issued by the Ministry, close to 14 hospital admissions are being registered every minute under PMJAY. Cashless treatments of more than Rs 17,500 Crores have been availed by the poor citizens under the Ayushman Bharat Yojana to date.

Beneficiaries Chose Private Hospitals over Government Hospitals

However, amid the COVID-19 pandemic, a lot of beneficiaries of PMJAY scheme preferred private hospitals over public hospitals. During the lockdown, they feared the risk of catching Coronavirus infection was higher in government hospitals. As per the analysis by the National Health Authority, which is the agency in charge of the scheme, the use of this scheme came down to half after the lockdown was imposed in the country.

Three reasons were listed for this on the NHA’s document, and they are given below:

• The first reason to avoid government hospitals would be the perception that they are treating COVID-positive patients. Since all the government-owned medical facilities focused on preparing for increasing coronavirus caseload
• Secondly, government hospitals could be too busy with COVID preparations. And all this might have delayed claim pre-authorization and submission for PMJAY beneficiaries’
• And the third reason could be due to dialysis cases that account for a large share of Ayushman Bharat scheme claims and is mainly provided in the private hospitals

COVID Fear Reduced the Frequency of the Claims

As per the NHA report, there has been a 51% decline in the average weekly claims under the PM-JAY scheme. The planned surgeries including cataract operations faced a decline of over 90%, and other important procedures like hemodialysis saw a decline of 6%. The report mentioned that the weekly nationwide PMJAY claims were 64% lesser than the average claim volume in just two weeks.

Recently, Harsh Vardhan, the Union Health Minister, visited the National Health Authority (NHA) to review the implementation of the health protection mission and the National Digital Health Mission. He got a full demo of the key systems of the National Digital Health Mission - eHospital, DigiDoctor, HealthID, Health Facility Registry, and Patient Health Records.

So, the move is to digitalize the healthcare system by creating a nationwide digital health ecosystem that enables patients to store, access and consent to share their medical records with doctors and medical facilities of their choice.

To avail of cashless benefits and digital services, the beneficiaries need an Ayushman Bharat Yojana Card.

Here is how you can download PMJAY Card Online?

To ensure cashless treatment and paperless transactions through the Ayushman Bharat Scheme, PMJAY golden card is issued to the beneficiaries. The PMJAY e-card holds all the details of the patient and is essential to furnish this card at the time of availing cashless treatment at the network hospital.

To get this cashless card, the process is given below:

• Login with your registered number of the PMJAY website
• To generate the OTP you need to enter the ‘Captcha Code’
• Now opt for the HHD code
• Provide it to the Common Service Centre to confirm
• Ayushman Mitra or the CSC representatives will complete the remaining procedure
• It will only cost you Rs.30 to generate the AB-PMJAY card

You can also avail of free COVID-19 treatment under this scheme at an empanelled private or public hospital. All you need to do is submit the Ayushman Bharat card and HHD number.

Bottom-Line

As you can see all the beneficiaries under PMJAY can avail of free or cashless treatment at any of the tertiary and secondary hospitals. The medical package has to be identified under the scheme at empanelled private and public hospitals.