IMA flags over Rs 1.21L cr unpaid bills under Ayushman Bharat; about 64 lakh cases stuck in limbo

New Delhi: The Indian Medical Association (IMA) has reportedly raised serious concerns over “delayed payments, low reimbursement rates, and complicated claim processes” under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) that “threaten hospital finances”. The concerns, according to an NDTV report, were raised in a white paper to the National Health Authority (NHA). The report, citing an RTI filed by Ajay Basudev Bose, stated that over Rs 1.21 lakh crore in claims (64 lakh cases) nationwide are still outstanding. “In Gujarat, Rs 300 crore in claims from 2021 to 2023 remain unpaid... Only 5% of these claims have been settled within the required 15 days. In Kerala, there are Rs 400 crore in pending dues...” The IMA also pointed out that package rates are too low and do not cover treatment costs, especially for complex procedures in private tertiary hospitals. “IMA should be invited while deciding rates, packages and we should ensure timely payments, ease of claims and simplified procedures,” the report quoted IMA national president Dr Dilip Bhanushali as saying. Uniform pricing discourages high-quality hospitals, resulting in only 67 of Delhi’s 1,000+ private hospitals participating due to operational and financial challenges. Claim rejections caused by technical errors further increase revenue losses, it added.

According to the report, the IMA recommends automating payments and creating real-time tracking for transparency; revising reimbursement rates to reflect actual costs and updating them regularly; simplifying claim documentation and providing 24/7 digital support (e.g., WhatsApp, SMS); setting up grievance redressal at district, state, and national levels; incentivising accredited and rural hospitals with higher payments and faster approvals; and moving to direct benefit transfers using fintech, avoiding third-party intermediaries, to improve efficiency and sustainability. The IMA, in the white paper, also recommended encouraging competition and addressing market failures, thus reducing payor biases and oligopsony effects that threaten small and mid-size providers. Minister Prataprao Jadhav acknowledged implementation challenges in the Rajya Sabha, urging states to adjust models for better efficiency. The IMA’s white paper, submitted to the Rajya Sabha Standing Committee on Health, is awaiting a response from the NHA. Doctors warn that without reforms, the scheme’s aim of providing free, quality healthcare for India’s poorest is at risk.