State

AB-PMJAY not user-friendly: Pvt Hospitals

Correspondent KOHIMA, SEP 12 (NPN) | Publish Date: 9/12/2020 12:20:42 PM IST

Leading private hospitals in Kohima have revealed that the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY)— flagship health assurance scheme of the Government of India— was not user-friendly despite the state having 2.43 lakh AB-PMJAY e-card holders as of September 5, 2020.

With all the district hospitals designated as COVID-19 hospitals, the state government empanelled private hospitals, which were earlier not empanelled, to provide an alternative for hospitalized care to PMJAY beneficiaries.
The leading hospitals in Kohima have, however, expressed dismay over the delay and mode of payment by the insurance company and the rates being very poor. They said the system of payment by insurance company was very poor, adding that pending bills in one hospital alone was more than Rs.30 lakh.
In an interview with Nagaland Post, Dr. Kezhalezo Angami of M/S Bethel Medical Centre informed that Ayushman Bharat scheme was good for the poor, but it was not a user-friendly. Dr. Kezhalezo Angami that Bethel medical centre has been taking e-card holders since the last two years. However, he said that since the payment was not made on time, it has stopped for some time. However, with the outbreak of COVID-19, the hospital resumed to treat PM-JAY e-card holders, he added.
Dr. Kezha said that the insurance company, which was supposed to pay the bill within two weeks, normally pays after delaying for months and that too in lump sum without specifying for which the bill was paid. He said government insurance companies must be given preference. Further, he said that many e-card holders were not well informed about when to use the card. Dr.Kezha said the patients mostly submit the card during the time of discharge leaving the hospital in tight situation. Mentioning about the poor rates, Dr. Kezha said suggestions were put forth to the health department for revised rates as the present rate was too poor for the hospitals to continue.
Raising similar issue, Dr. Vikethonyü Kesiezie, managing director Oking hospital and research clinic Pvt. Ltd, said the rates were “ridiculous”. He reminded that hospitals were not getting any profit out of the PM-JAY. However, since the hospital cannot afford to deny health services to the poor people, they have resumed accepting PM-JAY e-card holders.
According to Dr. Kesiezie, after a gap of two/three months the hospital received some payment few days back of about Rs. 14-15 lakh and about Rs. 30 lakh balance was yet to be paid by the insurance company. 
He said it was discouraging that dues were not cleared on time while the hospital, considering the poor condition of the patients, cannot deny them healthcare.
Dr. Kesiezie also raised the issue of patients submitting e-card while being discharged and said they must be well informed about the usage of card.
To queries, he said Oking hospital remained committed to serve the people, but regular payment by the insurance company would help the hospital treat many more patients.
Meanwhile, when contacted, state nodal officer AB- PMJAY, Dr. Kika Longkumer, told Nagaland Post that private hospitals were empanelled for specific specialties based on the facility available in the hospital. He said the issue of delay in payment by the insurance company was sorted out and claims are being cleared.
To queries on the revised rates, Dr. Longkumer said Nagaland was already given additional 10% incentives to private hospitals, which was above the national rates. He said also said that separate incentives were placed for hospitals with National Accreditation Board for Hospitals and Health Care providers (NABH), teaching hospitals and hospitals in aspirational districts.
According to Dr. Longkumer, State Health Agency (SHA) has been having frequent reviews and reminders with the insurance company to clear claims on time as per MoU terms.
He said state share for two premium instalments out of three have already been released to the insurance company. Dr. Longkumer said that insurance company started clearing more claims recently.
Dr. Longkumer said that any genuine PMJAY e-card holder, who was denied treatment or any other PMJAY benefit in empanelled hospitals, should raise their grievances through online portal https://cgrms.pmjay.gov.in or should inform the respective local health authorities. 
 

-Tags:#AB-PMJAY

Launched on December 3,1990. Nagaland Post is the first and highest circulated newspaper of Nagaland state. Nagaland Post is also the first newspaper in Nagaland to be published in multi-colour.

Desk:+91-3862-248 489, e-mail: npdesk@gmail.com Fax: +91-3862-248 500
Advt.:+91-3862-248 267, e-mail:npostadvt@gmail.com

QUICK LINKS

SUNDAY POST

Join us on

© Nagaland Post 2018. All Rights are Reserved
Designed by : 4C Plus