Sad news for patients; mass quitting of PM-JAY Aayushman scheme by hospitals in Punjab
Kanwar Inder Singh/ royalpatiala.in
Annoyed with problems being faced by Aayushman Empanelled hospitals, an Emergency meeting of IMA-Punjab was called at Ludhiana yesterday 10-10-2021, more than 300 doctors from all over Punjab, who are having their hospitals empanelled with PM-JAY along with all IMA branch Presidents & Secretaries attended it and submitted authority letter to IMA Punjab for “Mass Quitting” of scheme.
The problems being faced by hospital were discussed during this 5 hours long Marathon Meeting in details, along with causes behind them and Guidelines of NHA ( National Health Agency), Tripartite MOU and Tender Documents of SHA for selection of Insurance Company.
It was found that in the rate race of competition to grab the tender by all means Insurance Companies file the tender at such a low quotation that later it has to manipulate things to sustain in the scheme.
Previous Insurance company in the mid of the year when got exhausted of funds brought out a tricky solution to decrease claims by getting reserved 194 treatment modalities only for Government Hospitals and Present Insurance company SBI General is again pressing upon the Government to further reserve few more packages for Government hospitals only.
Here Insurance Company & State Govt. by virtue of their this action are “HANDS IN GLOVES” in depriving the public from getting real benefits of the scheme as the basic motive of the scheme is that both Rich & Poor get the equal medical facilities specially at Private hospitals because at Government Hospitals already all the treatments are to be provided free as it is duty of state government but here the state Govt. has also discovered a channel to siphon the funds of PMJAY to the state treasury by reserving these 194 packages so that patients get treated at Government Hospitals and Government earn money out of it whereas Government is supposed to do it free.
If we talk of reservation of packages in Punjab 194 packages are reserved whereas in nearby states of Rajasthan, Haryana & Himachal only 30-40 packages are reserved but in Punjab almost all packages of Gynae -Obstetrics and Ophthalmology are reserved so patients are bound to go to govt. Hospitals or have to spend their pockets if they want to go to private hospitals.
Now to save their money the SBI General Insurance has started harassing and humiliating hospitals in many ways-
1.Delayed Authorisation ( Turn Around Time (TAT) 6hrs/2hrs) : Patient has to wait for 2 to 3 days for start of treatment which wastage of resources and manpower.
2.Delayed Claim Settlement (TAT 15 Days)
3. Unneccesary queries for claim settlement (Post Op USG/HPR)
- Harassment of Inspections by BAMS/BDS/BHMS : and Many of the Empanelled hospital have received Show cause notices and suspensions based on their reports which is violation of NHA Guidelines & Tender Documents As per NHA Guidelines and Tender Documents only MBBS or doctor with higher qualification is eligible to do medical audit.
5.Medical Audit Not as per guidelines & Template of NHA
- Hospital Audit not as per Guidelines & Template of NHA
7.Claims deducted even after authorisation
8.Claim rejection on flimsy grounds
- Disrespect to the Hospital and doctors by inspection team
10.No Timely Payments : No payments for last 40 days.
Sad news for patients; mass quitting of PM-JAY Aayushman scheme by hospitals in Punjab. IMA-Punjab have had several meetings with previous Health Minister Balbir Singh Sidhu, Chief Secretary Health & CEO State Health Agency and was hopeful by virtue of their assurance that problems will be redressed but after taking over of Insurance part by SBI General things have rather turned more sore and difficult.
IMA-Punjab, looking upto sentiments of members, had discussion in core committee and has decided to think of most extreme step of Mass Quitting if problems are not resolved in given time frame.
October 11,2021
