Ayushman Bharat Pradhan Mantri -Jan Arogya Yojana (AB PM-JAY) provides treatment corresponding to a total of 1949 procedures under 27 different specialties including orthopedics, oncology, cardiology and general medicine, etc. Of these, a total of 141 procedures are related to orthopedic diseases. Further, as on 4th of December 2023, 20.25 lakh hospital admissions worth approximately Rs. 5,289.4 Crores have been authorized under the scheme for orthopedic-related treatment.

AIIMS is the apex tertiary care hospital in the country and therefore it attracts patients from across the country. AIIMS while admits the emergency cases immediately, it sometimes provides a subsequent date in case of elective surgery based on the bed availability. Patients seek support from implementing authority under AB PM-JAY for early date of surgery/ admission. Wherever possible, support is provided to the beneficiaries. Out of 4,198 such grievances received from across the country against different empaneled hospitals, 4,117 have been resolved. Further, 16 such grievances have been received with regards to AIIMS, Delhi, all of which have been resolved successfully.

The hospitals empaneled under AB PM-JAY are bound to offer cashless treatment to eligible beneficiaries for the specialties it has been empaneled. Failure to do so may result in penal action which may include, de-empanelment. In case beneficiaries are denied treatment, one can lodge grievance on the portal, through national call centre 14555 or through mail, letter, fax etc. which will be acknowledged, recorded, escalated and resolved as per well-defined process. All grievances of AB PM-JAY beneficiaries are resolved in an efficient, transparent and time bound manner through a three-tier grievance redressal structure.

A Central Grievance Redressal Management System (CGRMS) has been established for any complaint received either through the national call centre or on grievance redressal portal (https://cgrms.PM-JAY.gov.in/) or through any other medium. The same is immediately assigned to respective State Grievance Nodal Officer designated at each SHA for necessary action. Many times, grievances are raised by the beneficiaries due to lack of awareness e.g. grievance registered against a hospital for not providing treatment under specialty for which it has not been empaneled.

The Union Minister of State for Health and Family Welfare, Prof. S.P. Singh Bhagel stated this in the written reply in the Lok Sabha today.