Tussle between SHA & IFFCO-TOKIO: Delayed payments hits J&K’s AB-PMJAY SEHAT empanelled private hospitals

Srinagar, June 13: The tussle between State Health Agency and private insurance company IFFCO-TOKIO has pushed the private hospitals in Jammu and Kashmir, empanelled with Ayushman Bharat Scheme, to the wall over delay in payments since March this year.
Over the past three months, the private hospitals and diagnostic centres empanelled with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) SEHAT Scheme in J&K have been suffering and their payments are pending with SHA.
Owing to the issues, private hospitals in Jammu have stopped taking new cases under the health scheme stating that they are unable to provide services due to pending payments.
Initially, the health insurance scheme was implemented through private insurance company 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 Nov 2023, a year before its contract. Despite the SHA’s request for the company to continue the contract 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 fulfill the contract until its expiry on March 14, 2025.
Due to the tussle, hospitals and diagnostic centres in J&K face financial issues as they haven’t received payments till date leaving them to suffer.
Empanelled Private Hospital and Diagnostic Centres Association J&K have written to Chief Secretary J&K stating that they have not received the payments since March 15. They had already communicated to govt. that they will be unable to continue with the said scheme from 01 June, 2024.
Some officials argue that the scheme is functioning normally and issues between government and the concerned insurance company would not affect its implementation.
However, Sanjiv M. Gadkar, Chief Executive Officer, State Health Agency, J&K said private empanelled hospitals are key stakeholders in implementation of free treatments to the beneficiaries under the Ayushman Bharat scheme.
“In the past two years, the private Hospitals have been paid regularly as per the guidelines of the scheme without any interruption. The primary cause of the delays in payments to the private empanelled hospitals is the ongoing legal proceedings involving IFFCO-TOKIO General Insurance Company for the premature attempt to exit from contract from 15th March 2024, which was initially set to run until March 2025 (contract is for 3 years tenure),” he said.
He said the government is aware of the issues concerning delayed payments by the insurance company to the private empanelled hospitals and dialysis centers under the AB-PMJAY/SEHAT scheme.
“We acknowledge the financial strain these delays have imposed on our healthcare partners due to non-payment from the side of IFFCO Tokio. The empanelled private hospitals have also sought interim relief from the High Court and the Private Empanelled hospitals are fully ceased of the legal matter,” said Gadkar.
The CEO said J&K govt. held extensive discussions with private healthcare providers and has assured them of a timely resolution of the payment-related issues.
“SHA has assured all private empanelled hospitals that their money is safe and the government ensures that all pending payments are cleared as swiftly as possible,” he said.
The SHA has expressed gratitude to the private empanelled hospitals and dialysis centres for their commitment in implementing the scheme, despite not receiving payments.
It has appealed to all the empanelled private hospitals to continue treating patients under the scheme and to discharge their responsibility as a responsible partner under the scheme.
“The govt. is steadfast in its commitment to support empanelled hospitals and ensure uninterrupted delivery of healthcare to beneficiaries across J&K,” he said.
Gadkar said that the health and well-being of citizens of J&K remain the top priority and SHA J&K is committed to uphold the objectives of Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana/SEHAT.
“The govt. will take all necessary steps to ensure that all patients get desired treatments free of cost under the scheme and scheme shall continue without interruption. The patients are advised to call the toll free number 14555 or call centre 104 for any assistance related to their treatment under the scheme,” he added.