Srinagar, June 9: Private hospitals and dialysis centres across Jammu and Kashmir have announced a proposed de-empanelment from the Ayushman Bharat–SEHAT Scheme with effect from July 1, 2026, citing prolonged delays in reimbursement of claims, alleged non-compliance with National Health Authority (NHA) guidelines, and mounting financial pressures threatening the continuity of patient care.
The Jammu and Kashmir Private Hospitals and Dialysis Centres Association (JKPHDA) said that despite repeated representations before the concerned authorities, payments for approved claims under the scheme have remained pending for extended periods, placing severe operational and financial strain on empanelled healthcare institutions.
“Delivering essential healthcare services such as dialysis, intensive care, surgeries, emergency treatment, oncology care, cardiac interventions and trauma services requires uninterrupted availability of medicines, consumables, skilled healthcare professionals and properly maintained medical equipment,” a spokesperson of the Association said.
The Association stated that delayed reimbursements, coupled with deductions and rejection of claims without an effective review mechanism, have made it increasingly difficult for private healthcare providers to sustain quality services under the flagship health insurance scheme.
JKPHDA also highlighted the impact of the ongoing conflict in the Middle East, claiming that disruptions in global supply chains and rising healthcare costs have worsened the situation. It said the availability and pricing of critical cancer drugs, including Cisplatin and Carboplatin, have been adversely affected, making it difficult for oncology centres to maintain adequate inventories due to blocked reimbursements.
The Association further said that similar challenges are being faced in cardiology and orthopaedics, where procurement of cardiac stents and orthopaedic implants requires substantial working capital. The continued delay in payments, it alleged, has constrained hospitals from procuring life-saving medical products, potentially affecting patient care.
According to JKPHDA, more than ₹180 crore of Ayushman Bharat funds are reportedly lying unutilized with public hospitals, while private hospitals and dialysis centres continue to await payments for approved claims.
“Such a situation raises serious concerns regarding the efficiency of fund utilisation and reimbursement processes. Payment mechanisms for public and private healthcare institutions should be segregated and streamlined to ensure transparency, accountability and timely disbursement of funds,” the Association said.
The body also expressed concern over increasing waiting periods for certain procedures, including gall bladder surgeries and haemorrhoidectomies, alleging that these services have increasingly been restricted to public hospitals where patients are reportedly facing delays extending beyond ten months.
JKPHDA maintained that the prolonged delay in settlement of claims is inconsistent with the timelines prescribed under NHA guidelines and contractual provisions governing the scheme. It further claimed that under Section 6 of the Memorandum of Understanding (MoU), empanelled institutions are entitled to one per cent interest per week on delayed payments, which has not been provided.
In view of the prevailing situation, the Association announced that private hospitals and dialysis centres across Jammu and Kashmir have resolved to initiate de-empanelment from the Ayushman Bharat–SEHAT Scheme from July 1, 2026, unless immediate corrective measures are undertaken by the authorities.
The Association demanded immediate clearance of all pending claims along with applicable interest, establishment of a transparent mechanism for review of rejected claims, strict adherence to NHA guidelines on claim processing and payment timelines, segregation of payment systems for public and private hospitals, restoration of patient choice under the scheme, and urgent engagement with representatives of private healthcare institutions.
Reiterating its commitment to public welfare, JKPHDA said private healthcare providers remain dedicated to the objectives of the Ayushman Bharat–SEHAT Scheme. However, it cautioned that quality healthcare services cannot be sustained indefinitely without timely reimbursement, warning that the financial viability of several empanelled institutions is under severe stress, potentially disrupting critical services for thousands of beneficiaries across Jammu and Kashmir.
The Association appealed to the Union Territory Administration, the State Health Agency and other concerned authorities to intervene urgently, clear outstanding dues, comply with NHA norms and ensure uninterrupted healthcare services under the Ayushman Bharat–SEHAT Scheme in the larger public interest.(KNC)
