Pending payments to pvt hospitals: Waiting for final orders from HC: CEO, SHA

Srinagar, July 09: Patients in Kashmir have started bearing the brunt of pending payments to private hospitals empanelled with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) SEHAT Scheme.
On Tuesday, Ghulam Hassan, a dialysis patient from Srinagar, went to a private hospital in Srinagar empanelled with AB-PMJAY and needed a cap costing around Rs 14,000.
“Due to the payment issues, the hospital could not give it under AB-PMJAY. Later, we were compelled to buy it from the open market from our own pocket. Had the hospital done it under the scheme it would have saved us. The amount is unaffordable for poor patients,” he said.
The patient said that they previously received treatment for free under the insurance scheme. However, since payments to private hospitals were stopped, many patients are now bearing the brunt of these delays.
The government has said that the pending payments of private hospitals empanelled with AB-PMJAY SEHAT Scheme in J&K will be released once the issue of the insurance company with SHA is resolved.
There is a dispute between SHA and the concerned insurance company due to which the payments of empanelled private hospitals and diagnostic centres in J&K are pending from March 2024 leaving the private hospitals to suffer.
Chief Executive Officer, State Health Agency, J&K, Sanjiv M. Gadkar, stated that they have communicated with private healthcare providers and assured them that their payments will be released once the issue is resolved.
“We had a discussion with all the private hospitals in J&K and we have told them that money is not the issue. We are waiting for final orders from Jammu and Kashmir High Court,” he said.
The CEO said they are aware that hospitals are not getting the payments and all the hospitals are providing services to patients. “Every day the same number of procedures are conducted in hospitals. There is no issue with patients,” he said.
The health insurance scheme was started in J&K to provide healthcare coverage to all residents. The scheme was initially implemented through Bajaj Allianz General Insurance Company Limited, whose contract ended in 2022, after which IFFCO-TOKIO was roped in.
However, citing financial losses, IFFCO-TOKIO attempted to exit the scheme in November 2023, a year before the end of its three-year contract. Despite the SHA’s request for the company to continue the contract in the interest of patient care, the request was denied.
Officials said later the SHA approached the High Court to stay the exit and urged HC to order the insurance company to fulfil the contract until its expiry on March 14, 2025.
Previously, private hospitals and diagnostic centres empanelled with AB-PMJAY SEHAT Scheme in J&K had stated to stop their services due to pending payments with the State Health Agency (SHA).
The private health care providers also allege that patients do not get treatment properly in hospitals saying that distributors have also supported supplying them medical equipment.
“Due to the dispute, many hospitals and diagnostic centres in Jammu and Kashmir are facing financial issues; they have not received payments till date from the SHA due to which they suffer a lot,” said one of the owners of a private hospital in Srinagar.
Earlier, the empanelled Private Hospital and Diagnostic Centres Association J&K had written to Chief Secretary J&K over the pending payments since March 15.
The private healthcare providers face difficulties proceeding with Ayushman cases due to financial crunch. Despite that they said they have continued to provide benefits to patients under the scheme.