New Delhi: For 26-year-old M Divya, an Ayushman Bharat cardholder from Tamil Nadu living in Delhi, Dussehra last year turned into a nightmare. On Oct 2, her 52-year-old father developed severe stomach pain — triggering a desperate scramble across hospitals in east Delhi. Despite holding a national health insurance card meant to guarantee cashless treatment anywhere in India, the family was forced to run from one hospital to another as facility after facility refused care. They first took him to Lal Bahadur Shastri Hospital, where doctors gave him an injection, prescribed medicines and sent him home. When the pain did not subside, a local doctor advised them to consult the surgeon who had operated on him at Jeevan Anmol Hospital in 2003. But the family was told the surgeon would only be available two days later. Still searching for help, they went to Kukreja Hospital in Mayur Vihar for an ultrasound. Doctors there diagnosed a hernia and advised urgent surgery. However, when the family asked about availing treatment under the Ayushman Bharat scheme, they were told the hospital was not empanelled. With a diagnosis in hand, Divya then approached Dharamshila Narayana Hospital, an empanelled facility. According to the family, they were told the hospital accepts only “north-side” Ayushman cards and not cards issued in Tamil Nadu.The hospital administration did not respond to queries sent by TOI. The ordeal continued at Goyal Hospital in Krishna Nagar, where the family was again told the Ayushman card would not be accepted. Both Kukreja and Goyal hospitals are not listed as empanelled facilities on the Pradhan Mantri Jan Arogya Yojana (PMJAY) portal. With the patient’s pain worsening and no hospital willing to admit him using an “out-of-state” card, Divya said they returned home exhausted and frightened — until her grandmother insisted they try Delhi govt–run Lok Nayak Hospital. Finally, her father was admitted there and operated upon. “We later realised this is not an isolated incident. Despite having an Ayushman card, no hospital was ready to admit us,” Divya said. Several families across Delhi and NCR have reported facing similar roadblocks, with hospitals either citing non-empanelment or refusing “out-of-state” Ayushman cards, despite the scheme’s promise of seamless national portability. With Delhi drawing migrants from across India for work, portability failures affect thousands who rely on the scheme outside their home states. A senior Delhi government health official told TOI that the problem often stems from state-level restrictions within Ayushman Bharat (PMJAY). “Some states reserve certain treatments for their own govt hospitals. Those packages may not appear for private hospitals in another state because the claim is paid by the home state,” the official said. However, he added that hospitals are not permitted to deny treatment simply because a patient’s Ayushman card is issued by another state. Officials from the National Health Authority (NHA) stressed that PMJAY allows beneficiaries to seek treatment at any empanelled hospital across India. “Private hospitals cannot deny treatment on the grounds that the card is from another state. If a specific procedure is not empanelled, they may say so — but refusal based on card origin is not allowed,” an NHA official said. Patients denied care can call 14555, a toll-free helpline, which triggers an SOS grievance. It is usually resolved within five hours. According to Dr Narin Sehgal, Delhi state secretary of Association of Hospitals Organisation, private hospitals flag low package rates in the scheme, delayed payments, arbitrary claim deductions and the lack of an effective grievance redressal mechanism. He said patients from other states are particularly affected, with payments often remaining pending for long periods.Delhi joined PMJAY in April 2025. Since then, 984 patients from Delhi have received treatment in other states, with Rs 2.5 crore paid in claims up to Nov 14. Nationally, since the scheme began in 2018, around 1.6 lakh out-of-state patients have been treated in Delhi, with their claims totalling Rs 907 crore. For beneficiaries, the gap between entitlement and access can mean the difference between relief and risk. For Divya’s family, the numbers offered little comfort. “We had the card,” she said. “But when we needed help the most, only a govt hospital stepped in.”
