“Faith Shaken”: Patients, Doctors Reveal Cracks in Ayushman Bharat Scheme
Mumbai case reveals Ayushman Bharat's gaps, leaving patients and hospitals in distress.
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On the morning of 29 July, around 5:30 am, Mumbai-based writer, actor, and filmmaker Divya Unny’s 79-year-old father collapsed in his Mulund East home and needed urgent hospitalisation.
Even though he held both a private health insurance policy and an AB-PMJAY card, she first chose to try accessing care through the government programme.
Unny shared a reel about her experience with the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (AB-PMJAY). The central government’s flagship health insurance scheme, which promises free hospitalisation, is implemented in Maharashtra alongside the state-run Mahatma Jyotirao Phule Jan Arogya Yojana (MJPJAY).
What followed, she now describes as a “horrific” day that exposed the deep gaps in India’s health safety net.
A Maze of Phone Calls
Unny lives nearly an hour away from her father. As she rushed towards Mulund, she began calling hospitals empanelled under the MJPJAY–AB-PMJAY network to arrange care. She dialled eight hospitals that morning—including Apex, Cooper Hospital, Nair Hospital, Jupiter Hospital, and Platinum Hospital— only to be met with refusals, non-responses, or contradictory information.
At Jupiter Hospital, the response left her stunned.
Frustrated, she turned to the government’s helpline. The answer did little to reassure her. “I asked them what’s going on, why are hospitals not responding. And they said, ‘ma’am, aapko website main jaana padega. You will have to check. Aapke father ka problem kya hai, uske hisaab se aapko hospital designate kiya jayega.’ (the hospital will be asigned to you based on your father's illness. The process has to be done online.)”
When she called Apex Hospital, staff told her to first bring her father in, and only then would doctors decide whether he was eligible. “I told them I had the card, and I shared the card with them. But none of that worked."
Apex hospital told her that they are not affiliated with AB-PMJAY, however the health ministry in an email to Unny stated otherwise.
By the end of the ordeal, Unny had tried 24 hospitals. None provided the care her father urgently needed. Exhausted and out of time, she admitted him to a private hospital in Mulund East, paying out of pocket.
The Quint reached out to a Mumbai-based musician on Instagram, who lost him mother due to negligence of the same scheme. On condition of anonymity, he shared this message with us.
Screenshot of a message a Mumbai-based musician shared with us.
(Photo source: Accessed by The Quint)
Problems with the Yojana
Her viral Instagram reel about the experience forced the state health department to respond.
Officials visited her father in the hospital, took photographs and a written complaint. But little changed.
“In my mind, I’m thinking, either I’m going to get compensated or they’re going to offer for my father to get treated elsewhere. But none of that happened,” she said.
A senior official, Dr Shrikant from Government Health Department, called to apologise: “We are sorry this happened.” But there was no solution.
(We reached out to Dr Shrikanth for a response, but we have not heard back).
Divya Unny's written complaint.
(Photo source: Divya Unny)
A health policy expert, speaking on condition of anonymity, said Unny’s ordeal is far from unusual and reflects deeper structural issues. “Blame doesn’t fall squarely on somebody’s shoulders. This is a social insurance scheme for the lower 40 percent of society. In absolute numbers, that’s a huge task. And I don’t think we have an apparatus for that. The machinery is not geared for it.”
The bigger questions, the expert argued, are about funding. “Has money been allotted in budgets? If even 2 percent of this 40 percent population goes to private hospitals, that’s a huge amount. Once you have mobilised the population to come forward and avail services, and then you fail to fulfil, that becomes a victim. That is what that young lady must have been facing.”
He added, “even in Bengal, under Mamata Swasthya Sathi Card, the same thing is happening. Corporate hospitals are not honouring renewals. So what’s the point of a token card which isn’t honoured? It is about political expediency from all sides."
Hospitals Caught in the Middle
Doctors also say hospitals are struggling to sustain the scheme. Dr Manish Agarwal, an Orthopaedic and joint replacement surgeon in Rajasthan, Sudha Hospital compared AB-PMJAY with state schemes like Bhamashah Yojana and Rajasthan Government Health Scheme.
“Most treatments are not covered. Not all hospitals are allowed to treat every disease. And the reimbursement part is poor as well as delayed. Payments are still pending many months later. My small hospital alone is owed more than one crore,” he told The Quint.
Dr Agarwal's hospital is owed dues more than one crore—around Rs 55 lakhs in pharmacy bills and another Rs 55 lakhs in hospital dues, "mine is a small unit. Bigger corporate hospitals are owed crores," he said.
The problem, he said, is compounded by impractical package rates. “Certain surgeries under anaesthesia are priced at Rs 4,000–5,000. It’s impossible to do that with medicines and consumables included. In orthopaedics, they put the same charges for a finger fracture and a pelvic fracture. It just shows a lack of knowledge.”
A medical student, who requested anonymity, shared a series of messages with The Quint. “It’s not just hurting the patients, but also the doctors providing care,” he said.
His parents run a hospital in Gujarat, and from what he has seen firsthand, he believes the scheme is failing on the ground.
Screenshot Divya Unny received from a medical student after her reel.
(Photo source: Divya Unny)
Screenshot Divya Unny received from a medical student after her reel.
(Photo source: Divya Unny)
Screenshot Divya Unny received from a medical student after her reel.
(Photo source: Divya Unny)
Delayed reimbursements under AB-PMJAY remain a nationwide issue— stretching from Jammu & Kashmir to Nagaland, and from Ranchi to Assam.
On August 7, 2025, the Indian Medical Association (IMA), Haryana launched a three week strike, during which more than 650 private hospitals suspended treatment under the AB-PMJAY scheme.
“We signed the scheme in good faith to serve the poorest patients, but we were forced to run hospitals on credit while officials made false promises and humiliated us,” Dr Mahavir Jain, President of IMA Haryana, was quoted as saying by Times of India.
Doctors report that the government currently owes over Rs 600 crore in pending claims, with some payments delayed for more than a year.
The strike was eventually called off after the government assured immediate release of all pending dues with interest, as well as the rollback of unjustified deductions, among other commitments.
The Bigger Picture
Experts argue that while the idea behind AB-PMJAY is noble—offering insurance to India’s most vulnerable—the execution is faltering.
The anonymous expert summed it up, "most primary and secondary care should be handled by government hospitals. Only the most critical cases should be purchased from the private sector."
Dr Agarwal agreed, “the intention is good—everyone should get treatment. But execution is not proper. The government should consult experts, revise packages, and fast-track payments. Otherwise, hospitals won’t participate, and patients will keep suffering.”
For Divya Unny, the promise of free healthcare for her father turned into a day of frantic phone calls, bureaucratic dead-ends, and eventual surrender to private care.
Her case highlights a troubling gap between the ambition of Ayushman Bharat and its reality on the ground.
And as experts warn, unless India invests in both public health infrastructure and the financial backbone of its insurance schemes, many more families will find themselves in the same position: holding a health card that, in their hour of need, does not open any doors.