Ayushman Hospital Refused Cashless Care? Call 14555 and File a CGRMS Grievance

If you are an eligible Ayushman Bharat PM-JAY beneficiary and an empanelled hospital refuses to provide a covered treatment on a cashless basis, asks you to pay for a covered package, or creates an unresolved problem during admission, you do not have to simply accept the demand.

The National Health Authority (NHA) operates a Central Grievance Redressal Management System (CGRMS) for PM-JAY beneficiaries and other stakeholders. Complaints can be raised online or through the 14555 PM-JAY helpline. National Housing Bank

But there is an important qualification: cashless treatment applies to eligible PM-JAY beneficiaries, at empanelled hospitals, for services/packages covered under the scheme. It does not mean every medical service at every hospital is automatically free.

Here is what to do if you believe a hospital has wrongly refused your PM-JAY benefit.

What Does “Cashless” Mean Under PM-JAY?

PM-JAY provides eligible beneficiaries with coverage of up to ₹5 lakh per family per year for covered secondary and tertiary hospitalisation at empanelled hospitals.

The scheme is designed to provide treatment on a cashless and paperless basis. NHA's beneficiary materials state that covered treatment includes medicines, diagnostics, implants and other expenses included within the applicable treatment package. National Housing Bank

This means that when a covered package is approved and provided under PM-JAY, the beneficiary should not ordinarily be asked to pay the package cost out of pocket.

NHA's hospital guidance specifically states that an empanelled hospital provides cashless hospitalisation to beneficiaries according to the applicable Health Benefit Package. National Housing Bank

When Can You Raise a Grievance?

A grievance may be appropriate when, for example:

  • An empanelled hospital refuses an eligible beneficiary a covered service
  • The hospital asks for cash for a covered cashless service
  • There is a problem with admission or treatment under PM-JAY
  • The hospital does not process the beneficiary's eligible treatment correctly
  • You face another scheme-related service problem

NHA's grievance guidelines allow AB PM-JAY beneficiaries to file grievances, along with healthcare providers and other stakeholders. National Housing Bank

An NHA operational document also specifically identifies cases where an empanelled hospital asks a beneficiary to pay for cashless services as a grievance situation. National Housing Bank

First Check: Is the Hospital Empanelled?

Before filing a complaint, verify that the hospital is actually part of the PM-JAY network.

PM-JAY benefits are provided through empanelled public and private hospitals. The scheme also supports portability, meaning an eligible beneficiary can receive covered treatment outside their home State at an empanelled hospital. NHA Beneficiary

If the hospital is not empanelled under PM-JAY, the normal PM-JAY cashless rules may not apply.

Keep evidence of the hospital's name and location.

Second Check: Is Your Treatment Covered?

Not every visit to a hospital is automatically covered under PM-JAY.

PM-JAY is primarily a hospitalisation-based health assurance scheme covering specified health-benefit packages.

Some services are excluded. For example, NHA's published FAQ identifies outpatient care, drug rehabilitation, cosmetic treatments, organ transplants and fertility treatment among exclusions under the scheme. Tech Support

So before concluding that a hospital has violated PM-JAY rules, establish:

Are you an eligible beneficiary?

Is the hospital empanelled?

Is the treatment/package covered?

Was the hospital asking for money for a service that should have been provided cashlessly?

These details matter when the complaint is investigated.

What If the Hospital Says “Pay First”?

Don't immediately hand over a large amount without understanding what you are being charged for.

Ask the hospital's Ayushman Mitra/PM-JAY desk:

“Is this treatment being processed under PM-JAY?”

Then ask:

“Which package or procedure is being used?”

And:

“Why is this amount being requested from the beneficiary?”

If the amount relates to a service that you believe is covered under the approved PM-JAY package, ask the hospital to explain the reason for the charge.

Keep the answer in writing where possible.

Who Is the Ayushman Mitra?

Empanelled PM-JAY hospitals have Arogya Mitras who are intended to help beneficiaries with enrolment, admission and the claims process. NHA's documentation describes Arogya Mitras as facilitators at empanelled hospitals who interface with beneficiaries and the PM-JAY implementation system. NHA Beneficiary

So if you are at an empanelled hospital and cannot get a clear answer from the regular registration counter, ask specifically for the:

Ayushman Mitra / PM-JAY help desk.

Step 1: Collect Evidence

Before filing a grievance, collect whatever evidence is safely available.

Useful information includes:

  • Hospital name
  • Hospital address
  • Date and time
  • Patient name
  • PM-JAY/Ayushman beneficiary details
  • Name of treatment/procedure
  • Doctor/department
  • Name of hospital representative, if known
  • Amount demanded
  • Receipt or estimate
  • Admission papers
  • Discharge papers, if applicable
  • Pre-authorisation details, if available
  • SMS messages
  • Photographs of relevant documents

You don't need to create a confrontation to obtain evidence.

If a hospital refuses to give you a document, simply record what happened and mention that fact in the grievance.

Step 2: Call 14555

The PM-JAY National Helpline is 14555.

NHA documentation identifies 14555 as the PM-JAY helpline and says grievances received through the call centre can be registered in the CGRMS system. National Housing Bank

Tell the call-centre representative:

  • You are an Ayushman beneficiary
  • The hospital's name
  • What treatment you need
  • What the hospital refused
  • Whether money was demanded
  • Whether you are currently admitted
  • Whether the situation is urgent

Ask for your grievance/reference number.

Write it down or take a screenshot.

PM-JAY Helpline

14555

NHA's support material also lists 1800-111-565 alongside 14555. Tech Support

Step 3: File the CGRMS Complaint

PM-JAY's grievance system is called the Central Grievance Redressal Management System (CGRMS).

The NHA grievance guidelines identify the CGRMS portal as the online route for lodging PM-JAY grievances. National Housing Bank

Official grievance portal:

PM-JAY CGRMS Grievance Portal

If you have already called 14555, the call-centre representative can register the complaint in the system.

Step 4: Describe the Problem Clearly

Avoid writing:

“Hospital is cheating everyone.”

Instead write exactly what happened.

For example:

“I am an eligible PM-JAY beneficiary at [hospital name]. On 3 October, I was advised admission for [treatment]. The hospital's PM-JAY desk informed me that I would have to pay ₹____ before treatment. I was told this treatment would not be processed under PM-JAY. I request verification of whether the treatment/package is covered and whether the amount demanded is permissible.”

This gives the grievance officer something specific to investigate.

Step 5: Mention If Treatment Is Urgent

If you are currently at the hospital and the issue concerns an urgent medical condition, say that clearly when calling 14555.

Do not delay medically necessary emergency care simply because you are waiting for a grievance response.

The NHA's technical guidance provides procedures for emergency cases, including mechanisms for identifying eligible PM-JAY beneficiaries when normal documentation cannot immediately be provided. Tech Support

If there is an immediate medical emergency, medical treatment and safety take priority. Use the hospital's emergency department and appropriate emergency services while also raising the scheme-related issue.

What Happens After You File?

Your complaint enters the PM-JAY grievance-redressal system.

The NHA's guidelines say that grievances received through the call centre are entered into CGRMS and that the system generates a Unique Grievance Number (UGN) and sends an SMS to the stakeholder. National Housing Bank

The complaint can then be routed to the appropriate grievance authority for examination.

A simplified process is:

You report the problem

↓

14555 / CGRMS

↓

Grievance registered

↓

Unique grievance number

↓

Concerned authority examines the complaint

↓

Hospital/state/NHA response

↓

Grievance disposal or further action

Save Your Grievance Number

This is extremely important.

Don't close the browser or end the phone call without recording the reference number if one is generated.

Keep:

UGN / complaint number + date + hospital name

in your phone.

If you later need to follow up, this information makes it much easier to locate the complaint.

Can the Hospital Be Asked to Explain the Charge?

Yes, the grievance process can examine allegations involving hospital service delivery and improper charging.

NHA's published grievance framework is specifically intended to address disputes and grievances involving beneficiaries, healthcare providers and other PM-JAY stakeholders. National Housing Bank

The investigation may require the hospital to provide relevant records or respond to the allegation.

That does not mean every complaint will automatically result in a finding against the hospital.

The facts, eligibility, package and circumstances have to be examined.

What If the Hospital Says the Package Is Not Covered?

Ask for clarification.

There can be legitimate situations where:

  • The requested procedure is not included in the applicable package
  • The beneficiary is not eligible
  • The hospital is not empanelled for the relevant specialty/package
  • The service falls under an exclusion
  • A required pre-authorisation has not been obtained
  • The requested service is outside the scope of PM-JAY

The correct response is not to assume that every refusal is illegal.

Ask:

“What is the reason the treatment cannot be processed under PM-JAY?”

Then include that explanation in your grievance if you believe it is incorrect.

What If the Hospital Is Asking for Money for a Covered Package?

This is a much more specific grievance.

NHA's documentation states that PM-JAY empanelled hospitals provide cashless hospitalisation according to the applicable Health Benefit Package and identifies asking beneficiaries to pay for cashless services as a grievance scenario. National Housing Bank

If you believe this is happening:

  1. Ask for the reason for the charge.
  2. Ask which package is being used.
  3. Request an itemised estimate/receipt where available.
  4. Photograph or preserve relevant documents.
  5. Call 14555.
  6. File the CGRMS grievance.
  7. Save the grievance number.

What If You Already Paid?

Don't assume that paying means the matter is over.

Keep:

  • Original bills
  • Receipts
  • Payment screenshots
  • UPI transaction details
  • Card receipts
  • Hospital estimates
  • Discharge summary
  • Prescriptions
  • PM-JAY documents

NHA's grievance system has previously specifically captured cases where beneficiaries reported that money was collected for PM-JAY treatment and registered those cases as grievances. National Housing Bank

When filing your complaint, state:

How much you paid + what you paid for + when + to whom/hospital + whether you were told the service was under PM-JAY.

Don't Pay Cash Without a Receipt

If a hospital says payment is required, ask for a proper bill or receipt.

Avoid handing over cash without documentation.

If you have already paid cash and received no receipt, mention that in your grievance.

Do not secretly record conversations if doing so would create a safety or legal issue. Your priority should be obtaining medical care and preserving whatever legitimate documentation is available.

What About Treatment Outside Your Home State?

PM-JAY benefits are portable.

NHA states that an eligible beneficiary can receive covered treatment at an empanelled hospital outside the home State on a cashless basis, subject to the scheme's applicable conditions. NHA Beneficiary

So if you live in one State and need treatment while travelling in another, your home State does not automatically prevent you from using PM-JAY at an empanelled hospital.

If an eligible, covered treatment is refused simply because you are from another State, mention that fact in your grievance.

What If the Hospital Has Poor Internet?

Technical problems at a hospital should not simply be treated as a reason to abandon the PM-JAY process.

NHA's technical guidance provides procedures for hospitals operating with poor or intermittent connectivity, including mechanisms for beneficiary verification. Tech Support

If the hospital tells you:

“The PM-JAY system is down, so you have to pay privately,”

ask the PM-JAY/Ayushman Mitra desk what alternative procedure is being followed.

If you believe the hospital is improperly shifting the cost to you, report the incident through 14555/CGRMS.

What If You Are Asked to Buy Medicines Separately?

This depends on the treatment and package.

NHA's beneficiary materials state that covered PM-JAY treatment includes medicines, drugs, implants and food during treatment, subject to the applicable package and scheme rules. National Housing Bank

But don't assume that every medicine purchased anywhere outside the hospital is automatically reimbursable.

Ask whether the medicine is part of the covered package and why you are being asked to purchase it separately.

If the explanation does not make sense, include the details in your grievance.

What If You Are Asked to Pay for an Upgrade?

PM-JAY coverage has conditions around room categories and upgrades.

For example, NHA's published FAQ states that if a beneficiary chooses a room upgrade, the expenses associated with the upgrade may not be covered under PM-JAY. Tech Support

So distinguish between:

A hospital demanding money for a covered PM-JAY package

and

A patient voluntarily choosing an upgrade or service outside the package.

They are not the same situation.

What Information Should You Put in a CGRMS Complaint?

Use this checklist:

Patient details

  • Name
  • PM-JAY/Ayushman identification details
  • Contact number

Hospital details

  • Hospital name
  • City/district
  • Department
  • Ayushman Mitra/desk details, if known

Treatment details

  • Diagnosis/condition
  • Procedure advised
  • Date of admission or proposed admission
  • Package/procedure name, if known

Complaint details

  • What the hospital refused
  • Amount demanded
  • What explanation was given
  • Whether treatment was delayed
  • Whether you already paid
  • Whether you are still admitted

Evidence

  • Bills
  • Estimates
  • Prescriptions
  • Discharge papers
  • Screenshots
  • Payment records
  • Relevant hospital communications

A Simple Complaint Template

You can structure your complaint like this:

Hospital: [Name]
Location: [City/District]
Date: [Date]
Patient: [Name]
Issue: I am an eligible PM-JAY beneficiary and was advised [treatment/procedure]. The empanelled hospital has [refused admission/refused to process the treatment under PM-JAY/asked for ₹___ for a cashless service].
What the hospital said: [Brief explanation]
Documents available: [Bill/estimate/prescription/etc.]
Request: Please verify whether the treatment/package is covered under PM-JAY and whether the amount demanded is permissible.

Keep the description factual.

What You Should Not Do

Avoid:

  • Threatening hospital staff
  • Arguing with doctors about package rules
  • Paying unofficial cash without documentation
  • Giving your OTP to someone claiming to be from PM-JAY
  • Posting sensitive patient records publicly
  • Sending Aadhaar/medical documents to an unverified WhatsApp number
  • Assuming every hospital refusal is automatically a violation

Use the official grievance system instead.

Protect Your Medical and Aadhaar Information

PM-JAY involves sensitive personal and health information.

NHA's privacy policy recognises beneficiary health and identity information as sensitive data and sets out safeguards around its handling. NHA Beneficiary

When filing a complaint:

  • Upload only relevant documents.
  • Avoid posting medical records publicly.
  • Don't share OTPs.
  • Don't share banking passwords.
  • Verify that you are using an official PM-JAY channel.
  • Keep copies of whatever you submit.

Your Ayushman Cashless-Care Checklist

If an empanelled hospital refuses or asks you to pay:

☐ Confirm the hospital is PM-JAY empanelled

☐ Ask for the Ayushman Mitra/PM-JAY desk

☐ Ask whether the treatment is covered

☐ Ask for the package/procedure details

☐ Ask why payment is being demanded

☐ Request a bill/estimate/receipt

☐ Keep prescriptions and medical records

☐ Call 14555

☐ File a CGRMS grievance

☐ Save the Unique Grievance Number

☐ Track the complaint

☐ Continue necessary medical care, especially in an emergency

The Bottom Line

PM-JAY is designed to provide cashless treatment for eligible beneficiaries at empanelled hospitals for covered health-benefit packages. National Housing Bank

If you believe an empanelled hospital has wrongly refused a covered cashless service or demanded payment for it, don't rely only on a verbal argument at the hospital.

Ask for the PM-JAY/Ayushman Mitra desk, document what happened, call 14555, and register the matter through CGRMS. The grievance system generates a unique reference number that you should keep for follow-up. National Housing Bank

14555 → CGRMS → Save the grievance number → Track the response.