Several healthcare institutes in Kashmir are complaining that the delay in release of payment on account of reimbursement for free treatment provided to golden card beneficiaries by these hospitals was hampering the implementation of free healthcare for all in Jammu and Kashmir.
Jammu and Kashmir administration has implemented Ayushman Bharat PradhanMantri Jan ArogyaYojana (ABPM-JAY) SEHAT scheme by virtue of which all residents of J&K are eligible to get free treatment for a number of ailments including surgeries.
However, the cumbersome exercise which follows after patient avails the free treatment has irked the hospitals, both in public as well as private sector.
“There are many loopholes which need to be plugged. Besides it, the delay in payments to be released by the insurance company is the main irritant. Many medical stores are denying the medicines and surgical equipment to patients under the golden card due to the fact that their previous payments are pending,” said an official of SMHS Hospital.
He said that there was a need to have a robust mechanism to redress all the issues including payment part so that the scheme works flawlessly.
A senior doctor of a private hospital said that they had pending bills amounting to over Rs 2 crore under the SEHAT scheme.
“The problem now is that we are not able to provide treatment to the patients as our suppliers deny medicines and surgical equipment besides even denying stents to heart patients,” he said.
Similarly, the healthcare institutions providing dialysis to chronic kidney failure patients are also complaining about delay in reimbursement of payments, which is hurting them economically.
“It is getting extremely difficult for us to keep the hospitals running as there has been a consistent delay in the payment of our claims,” they said.
Talking to Greater Kashmir, Nodal Officer for PMJAY in J&K, Atta ulMominTak said, “We have nothing to do with payment. The payment is reimbursed by the insurance company that usually releases the payment within 15 days of submission of online bills.”
He said that mostly the delay was due to the fact that those seeking reimbursement of bills had some documents missing, which the computer does not accept as a result of which the timeframe of 15 days for reimbursement take more time.
Tak said that the payments and acceptance of reimbursement was computer-operated process and there was no question of delay when all the requisite documents are in place.
The SEHAT scheme promises Universal Health Insurance Coverage of Rs 5 lakh per family on a floater basis, the same benefits available under Ayushman Bharat.
This scheme covers all residents of J&K including government employees, pensioners and those without any regular wages.
It pledges cashless access to healthcare services for the beneficiary at the hospitals empanelled by the government.
All the residents of Jammu and Kashmir would be covered under the scheme irrespective of their socio-economic status.
Medical procedures such as oncology, cardiology, nephrology are included in the scheme, the official said.
Beneficiaries could avail services from any of the 24,148 empanelled hospitals across the country under the AB-PMJAY’s portability feature.