“Faith Shaken”: Patients, Doctors Reveal Cracks in Ayushman Bharat Scheme

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.“I am privileged enough to be able to afford private treatment,” Unny said. “But I was seeing the loopholes with the Yojana. As a person who applied for it, with faith in the government, I felt really disheartened.”‘Went to Hospital in Auto’: Victims' Kin Question Govt's Failures at RCB EventUnny 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. “They said that only oncology patients are covered under the Yojana. And they also told me that Yojana has specific hospitals catered to specific treatments only—which is very new to me because the insurance is supposed to cater to everything which is an emergency except for pregnancies and cosmetic surgeries.”Divya Unny 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. "It was crazy because at that point in time, when a person is in need, you're not in a position to do all of this."Divya Unny Delhi’s Toxic Air is Laced With Microplastics: What It Means for Your HealthBy 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.It was an extremely difficult process, and by this time, 12 hours had already passed. If I had depended on the Yojana, and I would have had my father waiting, that would have been fatal.Divya UnnyThe 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.Ayushman Bharat: India's Healthcare Needs a Major Shift Towards Elderly CareHer 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).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.""It's a huge task to sort of govern, manage, dispense, and disperse. I don't think we have an apparatus for that. The machinery is not geared for that.Medical health policy expertAyushman Bharat & Poll Promises: Why ASHA Women Are in a 'Catch-22' SituationDoctors 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.“We did a surgery after getting pre-approval. Later, they rejected the claim over a small issue. So our payments since December–January are still pending. How can we keep treating patients if we don’t get paid?"Dr Manish Agarwal, Orthopaedic SurgeonDr 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.”"In private insurance, payments come within three to four weeks. Under Ayushman Bharat, even last year’s claims are still pending. Hospitals can’t keep functioning like this."Dr Manish Agarwal, Orthopaedic SurgeonCigarette Filters Don’t Protect Smokers’ Health, Only Cause Plastic PollutionA 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.Delayed reimbursements under AB-PMJAY remain a nationwide issue— stretching from Jammu & Kashmir to Nagaland, and from Ranchi to Assam.By February 2025, hospitals were still awaiting payments of Rs 12,161 crore, roughly 8.7 percent of the Rs 1.4 lakh crore worth of admissions authorised under the scheme since its launch in 2018, according to data obtained through an RTI query by activist Ajay Bose.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. The protest was held due to unpaid dues totalling Rs 400 crore, arbitrary deductions, and operational challenges that made it increasingly difficult for hospitals to function.“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.Dear Women, Here's Why You Need A Solid Health InsuranceExperts 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.""But for that, the public system needs massive investment. Health expenditure has to rise to 3–4 percent of GDP. It’s still below 2 percent. Unless we make those fundamental changes, stories like Divya’s will keep happening."Senior medical health expert 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.The message from doctors and policy experts is clear: revise packages, pay hospitals on time, build accountability, and invest more in public healthcare. Without these steps, Ayushman Bharat risks becoming a scheme of false assurances.Has GST Council Reduced Tax Rates on Life and Health Insurance? A Fact-Check

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“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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