Healthcare institutes decry delay in release of payments under SEHAT scheme

Healthcare institutes decry delay in release of payments under SEHAT scheme
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Srinagar: Healthcare institutions in Kashmir decry delay in release of pending payments under SEHAT scheme which envisages free treatment for the beneficiaries.

The healthcare institutions which are working with Ayushman Bharat on free health insurance schemes said that some portion of their payments for the treatment done by them was pending with the authorities “due to technicalities raised by the authorities”.

Jammu and Kashmir administration has implemented Ayushman Bharat Pradhan Mantri 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.

“Our bills are unpaid which were rejected due to technicality of not being presented on time. There was some confusion but that doesn’t mean we have not provided treatment under the scheme. We have been pleading before the authorities to clear the backlog bills, but they are giving one or the other excuse,” said an official of the Health department.

The private healthcare institutes are also complaining of delay in release of pending bills on account of work done under the SEHAT scheme.

“Without intimation, a clause of submitting bills within a day after treatment was introduced last year. We were not aware of this as a result of which our offices submitted documentation late and our claims were rejected. These bills have piled up and are creating problems as we are not able to pay our suppliers on time,” said an official of a private healthcare institute.

A senior doctor of a private hospital said that they had pending bills amounting to over Rs 3 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 the 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-ul-MominTak 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 takes more time.

Tak said that they were releasing payments on a timely basis.

However, he admitted that some bills which were auto-rejected due to the delay in their submission were being reviewed by the department.

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.

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