RTI for Ayushman Bharat Hospital Denial and PMJAY Treatment Records

Use this guide if (a) an empanelled hospital denied cashless treatment despite a valid PMJAY card; (b) the hospital downgraded the package or asked you to pay; © pre-authorisation was rejected without reasons; (d) the SHA's grievance cell is not responding; (e) you want the SECC eligibility entry that links your name to PMJAY; (f) you want to know whether the hospital is even on the empanelled list.

• PMJAY Operational Guidelines issued by NHA.
• Tripartite Agreement between NHA, SHA and the empanelled hospital, clause on patient acceptance.
• RTI Act 2005, Sections 6 and 7(1), including the 48-hour life-and-liberty proviso.
• Article 21 of the Constitution, right to health (per Paschim Banga Khet Mazdoor Samity v State of West Bengal (1996)).
• Clinical Establishments Act 2010 (where applicable).

The CIC has held in Anand Saxena v NHA (CIC, 2021) and similar cases that pre-authorisation logs, package code mapping and empanelment records are disclosable to the patient.

1. Identify the right PIO. Three layers: (1) NHA, Indian Habitat Centre, New Delhi; (2) SHA of your state; (3) District Implementing Unit (usually under the Chief Medical Officer).
2. Pin the visit. PMJAY ID, hospital name and code, date and time of attendance, OPD card or token, package code if known, treating doctor.
3. Use the body's own redressal first. PMJAY helpline 14555 / 1800-111-565, SHA grievance portal, pmjay.gov.in grievance.
4. Draft the RTI asking for the empanelment status, the pre-auth trail, the denial noting, the SECC eligibility entry and the SHA grievance file.
5. Mark life-and-liberty if applicable, when treatment is being delayed for a serious condition, invoke the 48-hour proviso.
6. Pay ₹10 fee through online RTI or IPO.
7. Wait 30 days (or 48 hours).

To,
The Public Information Officer,
[National Health Authority / State Health Agency / District Implementing Unit]
[Full address]

Subject: RTI under Section 6 regarding denial of cashless treatment under PMJAY at [Hospital name and code], dated [DD/MM/YYYY]

Sir / Madam,

I, [Full name / patient relationship], a citizen of India and a PMJAY beneficiary holding card / family ID [number], request the following under the RTI Act 2005. Fee of Rs. 10 paid online / by IPO.

In respect of the visit / admission of patient [Name] at [Hospital name and code] on [DD/MM/YYYY]:

1. Whether the hospital is on the PMJAY empanelment list as on that date, with effective date of empanelment.
2. Package code(s) corresponding to the diagnosis / procedure noted on the OPD or IPD record.
3. Pre-authorisation log: requests filed, reasons for rejection or downgrade, and SHA approver's noting.
4. Denial endorsement on the OPD card / admission slip and the reason recorded in writing.
5. Whether any payment was demanded; if so, the receipt number.
6. SECC eligibility entry linking my name to PMJAY for the present family ID.
7. Standard Operating Procedure for cashless treatment under PMJAY at empanelled hospitals.
8. Status of any grievance filed by me against the hospital, including ticket number, present custodian and reasons recorded.
9. Penalty action, if any, taken against the hospital under the Tripartite Agreement.

[If applicable: This is a life-and-liberty matter under the proviso to Section 7(1); reply is sought within 48 hours.]

I invoke Section 10 (severability). I undertake to pay further fee under Section 7(3).

Yours faithfully,
[Signature, name, date]

• Filing only with the hospital. Empanelled private hospitals are not directly RTI-amenable. Address NHA / SHA.
• Using the wrong card. PMJAY family ID, e-card and Ayushman Bharat Health Account (ABHA) are different. Identify the right one.
• Forgetting the SECC link. Many denials are due to “name not in beneficiary list”. Ask for the SECC link and the grievance route under Additional Beneficiary mechanism.
• Asking for “package upgrade”. PIO cannot upgrade. Ask for the package code rule and the pre-auth approver's reasoning.
• Skipping helpline 14555. Often resolves in hours; RTI is the backup.

• No reply in 30 days (or 48 hours) → First Appeal under Section 19(1).
• PMJAY grievance escalation → SHA appellate authority, then NHA grievance cell.
• Writ in High Court under Article 21 for denial of life-saving treatment.
• Consumer complaint for paid services after denial, if you paid out of pocket despite eligibility, you can seek refund through the SHA grievance cell or consumer commission.

No. The Tripartite Agreement and PMJAY Operational Guidelines require acceptance for the listed package. Refusal is grounds for action by SHA, including suspension and recovery of penalty.

Ask via RTI for the additional-beneficiary route notified by your state, and for the grievance file. Many states permit Antyodaya, BOCW and other identity proofs.

No directly, but a parallel writ under Article 21, backed by the RTI denial endorsement, has worked in many High Courts.

Yes, it is a registered society under DA&FW, financed entirely by the central government, with a designated CPIO.

The pre-auth trail, package code, denial endorsement, treatment records and bills. With death certificate and relationship proof.

Generally no, unless substantially financed. But under PMJAY, their conduct is regulated through SHA, which is the public authority.

Yes. NHA publishes it on pmjay.gov.in; if outdated, RTI to NHA / SHA gives the live list.

• National Health Authority: nha.gov.in
• PMJAY portal: pmjay.gov.in
• Ministry of Health and Family Welfare: mohfw.gov.in
• RTI Online: rtionline.gov.in
• CPGRAMS: pgportal.gov.in

Last reviewed: 9 May 2026.

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Ayushman Bharat denial — complete guide on challenging rejected Ayushman Bharat claims and cards through RTI:

1. Step 1: Common reasons for Ayushman Bharat denial. (a) card-related: (i) name mismatch — between the Aadhaar — and the Ayushman card, (ii) family not in the SECC 2011 database — or the eligible list, (iii) ration card number — not linked — or not matching, (iv) mobile number — not linked — or not verified, (b) claim-related: (i) pre-existing condition — not covered — or excluded, (ii) the treatment — is not in the approved package list — HBP (Health Benefits Package), (iii) the hospital — is not empanelled — or the empanelment — was cancelled, (iv) the claim — was not submitted — within the time limit — 48 hours for pre-auth — and 7 days for the final claim, (v) the documents — are incomplete — or mismatched, © hospital-related: (i) the hospital — refuses to treat — under Ayushman — despite being empanelled, (ii) the hospital — demands money — despite the Ayushman card, (iii) the hospital — refers the patient — to another hospital — without justification.
2. Step 2: Steps to challenge Ayushman Bharat denial. (a) Step 1 — get the reason in writing: ask the hospital — and the Ayushman Mitra — to provide the reason — for the denial — in writing, (b) Step 2 — file a complaint: file a complaint — with: (i) the hospital — to the Medical Superintendent, (ii) the SHA (State Health Authority) — on the toll-free number 14555 — or the Ayushman portal, (iii) the NHA (National Health Authority) — on the Ayushman portal — or the grievance portal, © Step 3 — escalate: if the complaint — is not resolved — within 15 days — escalate to: (i) the District Magistrate (DM), (ii) the Chief Minister's helpline, (iii) the Insurance Ombudsman — if the insurance company — is involved, (d) Step 4 — file RTI: file RTI — with the NHA — or the SHA — to get: (i) the card status, (ii) the claim status, (iii) the denial reason, (iv) the grievance status.
3. Step 3: File RTI on Ayushman Bharat denial. File RTI with the National Health Authority (NHA) or the State Health Authority (SHA) asking for: (a) the card: “Provide the status — of the Ayushman Bharat card — for [name], [ration card number], [Aadhaar number] — including: (i) the application date, (ii) the approval date, (iii) the rejection date — and reason — if rejected, (iv) the card number — if issued”, (b) the claim: “Provide the status — of the Ayushman Bharat claim — for [patient name], [hospital name], [claim number] — including: (i) the date of submission, (ii) the date of processing, (iii) the approved amount, (iv) the rejected amount — and reason — if rejected, (v) the payment date — and the amount — if paid”, © the grievance: “Provide the status — of the grievance — filed on [date] — reference number [number] — including: (i) the complaint details, (ii) the action taken, (iii) the resolution, (iv) the date of resolution”, (d) the hospital: “Provide the empanelment status — of [hospital name] — including: (i) the date of empanelment, (ii) the specialties covered, (iii) the cancellation — if any — and the reason, (iv) the complaints — against the hospital — and the action taken”, (e) the package: “Provide the approved package list — HBP — for [treatment name] — including: (i) the package code, (ii) the package amount, (iii) the inclusions, (iv) the exclusions”.
4. Step 4: The National Health Authority (NHA) as a public authority. (a) the NHA — is a public authority — under the RTI Act — and the CPIO — is the PIO — for the central-level queries, (b) the SHA — is the PIO — for the state-level queries — and the State Information Commission — hears the second appeals, © the NHA — has designated: (i) the CPIO — at the headquarters — in New Delhi, (ii) the APIOs — at the regional offices, (d) the RTI application — can be filed: (i) online — on the NHA website — nha.gov.in, (ii) by post — to the CPIO, NHA, New Delhi, (iii) in person — at the NHA office.
5. Step 5: Key legal provisions. (a) the Ayushman Bharat PMJAY — is a scheme — under the Ministry of Health and Family Welfare — and the NHA — implements the scheme, (b) the PMJAY — provides: (i) Rs 5 lakh — per family per year — for the secondary and tertiary care, (ii) cashless treatment — at the empanelled hospitals, (iii) no cap on the family size — and the age, © the denial — of the treatment — by an empanelled hospital — is a violation — of the PMJAY guidelines — and the patient can complain — to the SHA — and the NHA, (d) the Supreme Court — and the High Courts — have held — that the denial — of the medical treatment — under a government scheme — is a violation — of the right to life — under Article 21 — and the patient can approach — the court — for the treatment.
6. Step 6: Sample RTI application for Ayushman denial. “To, the CPIO, National Health Authority, New Delhi. Subject: Application under RTI Act, 2005 — for Ayushman Bharat card and claim status. Sir, I request the following information — under Section 6(1) of the RTI Act, 2005: (i) Provide the status — of the Ayushman Bharat card — for [name], [ration card number], [Aadhaar number], (ii) Provide the reason — for the rejection — of the card — if rejected, (iii) Provide the status — of the claim — for [patient name], [hospital name], [claim number], (iv) Provide the reason — for the rejection — of the claim — if rejected, (v) Provide the grievance status — for the complaint — filed on [date]. I am paying the application fee of Rs 10 — by IPO. Yours faithfully, [Name, Address].”
7. Step 7: Practical tips. (a) keep all documents (keep the Ayushman card — the Aadhaar — the ration card — the hospital bills — the discharge summary — and the claim documents — safely), (b) file the complaint promptly (file the complaint — within 15 days — of the denial — to avoid the time bar), © cite the PMJAY guidelines (if the hospital denies — cite the PMJAY guidelines — which require the empanelled hospital — to treat — without demanding money), (d) file RTI (if the complaint — is not resolved — file RTI — to get the status — and the reason — and to build the case), (e) approach the court (if the RTI — and the complaint — do not resolve — approach the High Court — for the treatment — and the compensation), (f) Example: A patient — was denied treatment — by an empanelled hospital — who demanded Rs 50,000 — the patient filed a complaint — with the SHA — and RTI — with the NHA — the RTI reply showed — that the hospital — was empanelled — and the treatment — was in the HBP — the patient filed a writ — in the High Court — the court directed the hospital — to treat — without money — and the NHA — to take action — against the hospital.

See Ayushman Denial RTI and Ayushman Card 2026.