Ayushman Card Cashless Denied? How to Complain to NHA

If an empanelled hospital refused cashless treatment under your Ayushman card or demanded an advance, lodge a grievance on the PMJAY CGRMS portal at https://cgrms.pmjay.gov.in or call the toll-free helpline 14555. An empanelled hospital denying cashless or charging you is a violation of its empanelment terms, and the National Health Authority can penalise or de-empanel it.

Short on time? Jump to the step-by-step complaint process below and start with the hospital Arogya Mitra desk, then file on CGRMS.

Ayushman Bharat PM-JAY gives each eligible family a cover of Rs 5 lakh per family per year for secondary and tertiary hospitalisation. Treatment at an empanelled hospital is meant to be fully cashless and paperless at the point of care.

Empanelled public and private hospitals cannot deny treatment for a covered disease, and they cannot ask you to pay out of pocket. They are legally bound by their empanelment agreement to provide cashless care and to raise the pre-authorisation with your State Health Agency, the SHA.

So a refusal, a “machine is down” excuse, or a demand for an advance deposit for a covered procedure is not a normal billing event. It is an empanelment violation you can report.

Dr. Shrawan Kumar Pathak helped a neighbour in Patna whose father was admitted for a covered cardiac procedure. The private hospital accepted the Ayushman card at the desk, then quietly asked the family to deposit Rs 40,000 “for now, adjust later.” The family nearly paid before checking.

This happens for predictable reasons. The hospital may want to avoid the pre-authorisation paperwork. The package rate paid by the SHA may be lower than the hospital's cash rate, so it stalls. Sometimes a junior at the desk simply does not know the case is covered.

None of these is your problem to solve by paying. The fix is to push the case to the Arogya Mitra, get the refusal on record, and escalate. Hospitals respond fast once a grievance docket exists, because penalties and de-empanelment are real.

Cashless rules only bind empanelled hospitals. Check at https://hospitals.pmjay.gov.in by selecting your State, District and Speciality, or read how to find a PMJAY empanelled hospital. If the hospital is empanelled for the speciality you need, cashless is your right.

Ask the hospital to put the refusal, or the advance-payment demand, in writing on its letterhead or by message. Most desks will not, so create your own record instead. Note the date, time, ward, the staff name, and the exact words used. Keep the admission slip, the card, and any payment receipt. This record is the spine of your complaint.

Every empanelled hospital has a Pradhan Mantri Arogya Mitra help desk. Ask the Arogya Mitra to verify your card and raise the pre-authorisation on the spot. If the desk stalls, call the 24-hour toll-free helpline 14555 from the hospital itself and tell the agent the hospital is refusing cashless. The agent logs the call and can push the hospital. Note the call reference.

Lodge a formal complaint on the Central Grievance Redressal Management System at https://cgrms.pmjay.gov.in. Register your details, choose the grievance type, describe the refusal, and upload your records from Step 2. The portal generates a Unique Grievance Number. Status updates come by SMS and email, so save the number to track your docket.

PM-JAY runs a three-tier grievance system at District, State and National levels, each with a nodal officer and a Grievance Redressal Committee. If the grievance is not resolved within 15 days, it can be referred to the District Grievance Redressal Committee. The expected redressal time is 30 days. If the district and your State Health Agency do not act, escalate to the State and then the National Grievance Redressal Committee under the National Health Authority.

A valid complaint is when an empanelled hospital refuses a covered, medically indicated treatment, demands an advance or deposit for it, asks you to buy medicines or implants that the package already covers, or stalls the pre-authorisation without reason.

It is not a valid cashless complaint when the procedure is genuinely outside the scheme, the hospital is not empanelled, your card or eligibility is not verified, or the Rs 5 lakh annual family cover is already exhausted. In those cases the bill is lawful. Confirm coverage first so your grievance stands on firm ground.

Pre-authorisation is raised by the hospital with your State Health Agency and is usually approved quickly for standard packages. If the hospital says it is “waiting for approval” for hours while asking you to pay, treat that as a stall. Call 14555, note the reference, and file a CGRMS grievance. The hospital, not you, owns the pre-authorisation duty, so a delay is never a reason for you to deposit cash.

Yes, you can seek a refund. File a CGRMS grievance at https://cgrms.pmjay.gov.in with the payment receipt, the admission record, and proof the hospital is empanelled for that treatment. Charging a beneficiary for covered cashless care breaches the empanelment terms, so the State Health Agency can direct the hospital to refund and can penalise it. Keep escalating up the three tiers until the refund is ordered.

Yes. Denying cashless or charging beneficiaries can lead to penalties and de-empanelment. In one parliamentary reply the government said it had de-empanelled 1,114 hospitals, suspended 549, and levied a penalty of Rs 122 crore on 1,504 errant hospitals. Your grievance feeds the same enforcement machinery, so filing it matters beyond your own case.

PM-JAY is built to be cashless, not a reimbursement scheme, so paying first and claiming later is not the normal route and is often refused. The safer path is to refuse the advance, escalate while admitted, and keep the care cashless. If you were forced to pay, raise a CGRMS grievance for a refund rather than assuming an automatic reimbursement.

14555 is the toll-free 24-hour helpline for Ayushman Bharat PM-JAY for scheme queries, empanelled hospitals, and grievances. Use it as your first phone channel from the hospital. The written grievance on the CGRMS portal is what creates a trackable docket, so always follow a call with an online complaint.

Save the Unique Grievance Number generated when you register on CGRMS. The portal sends status updates by SMS and email. If 15 days pass without resolution, the matter can move to the District Grievance Redressal Committee, and you can escalate to the State and National committees under the NHA.

• Open https://hospitals.pmjay.gov.in and confirm the hospital is empanelled for your treatment.
• Write down the date, time, staff name, and exact words of the refusal or advance demand.
• Call 14555 from the hospital and note the call reference.
• File a CGRMS grievance at https://cgrms.pmjay.gov.in and save the Unique Grievance Number.
• Do not pay any advance for a covered procedure until the Arogya Mitra and helpline have been pushed.

If your claim or refund stays stuck, file an RTI with your State Health Agency, the public authority that runs PM-JAY in your state. Ask for the pre-authorisation and claim status for your case ID, the action taken on your grievance number, and the action taken against the hospital. An RTI puts the SHA on a 30-day statutory clock and creates a paper trail you can use in a first appeal.

You can draft this in minutes with the AI RTI Drafter, and if the SHA stays silent, escalate with the First Appeal Builder. For the full method of turning a stuck grievance into pressure, read The RTI Playbook.

• National Health Authority, helpline 14555 confirmation: https://x.com/AyushmanNHA/status/1959861267813773820
• PMJAY CGRMS grievance portal: https://cgrms.pmjay.gov.in
• NHA hospital empanelment and de-empanelment guidelines: https://nha.gov.in/img/resources/Revised-Empanelment-and-De-empanelment-Guideline.pdf
• About PM-JAY, National Health Authority: https://nha.gov.in/PM-JAY
• AB-PMJAY de-empanelment and grievance process, Outlook Money: https://www.outlookmoney.com/retirement/plan/health-insurance/ab-pmjay-1114-hospitals-de-empanelled-and-549-suspended-for-fraudulent-activities-know-how-to-raise-a-grievance-under-the-scheme

• How to find a PMJAY empanelled hospital
• AI RTI Drafter for a fast RTI application
• First Appeal Builder for a silent authority
• The RTI Playbook