Ayushman Bharat's National Portability Promise Falters as Delhi Hospitals Refuse Out-of-State Cards
For 26-year-old M Divya, a resident of Delhi originally from Tamil Nadu, what should have been a festive Dussehra celebration last year transformed into a harrowing medical emergency. Her 52-year-old father developed severe abdominal pain on October 2, initiating a desperate and exhausting journey through multiple hospitals in east Delhi that exposed critical gaps in India's flagship health insurance scheme.
A Nightmare Journey Through Multiple Hospital Rejections
Despite holding an Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) card designed to guarantee cashless treatment anywhere in the country, Divya's family encountered repeated rejections when seeking care for her father. Their ordeal began at Lal Bahadur Shastri Hospital, where doctors administered an injection, prescribed medication, and discharged the patient without addressing the underlying condition.
When the pain persisted, a local physician recommended consulting the surgeon who had previously operated on her father at Jeevan Anmol Hospital in 2003. However, the family was informed this specialist would only be available two days later—an unacceptable delay given the patient's deteriorating condition.
The search for diagnosis led them to Kukreja Hospital in Mayur Vihar, where an ultrasound identified a hernia requiring urgent surgical intervention. Yet when the family inquired about utilizing their Ayushman Bharat coverage, they were informed the facility was not empanelled under the scheme.
Geographic Discrimination and Systemic Barriers
Armed with a diagnosis, Divya approached Dharamshila Narayana Hospital, an officially empanelled PMJAY facility. Shockingly, hospital staff reportedly informed the family they only accepted "north-side" Ayushman cards and would not honor coverage issued in Tamil Nadu. The hospital administration did not respond to media queries regarding this alleged geographic discrimination.
The pattern continued at Goyal Hospital in Krishna Nagar, where the family faced another rejection based on their out-of-state insurance card. Both Kukreja and Goyal hospitals are conspicuously absent from the official PMJAY portal listing of empanelled facilities.
With her father's pain intensifying and no private hospital willing to accept their "out-of-state" card, Divya described returning home "exhausted and frightened" until her grandmother insisted they try the Delhi government-run Lok Nayak Hospital. There, finally, her father received admission and underwent the necessary surgery.
Widespread Problem Affecting Thousands of Migrant Workers
Divya's traumatic experience is far from isolated. Numerous families across Delhi and the National Capital Region have reported similar obstacles when attempting to use Ayushman Bharat coverage, with hospitals either citing non-empanelment or refusing to honor cards issued in other states. This represents a fundamental failure of the scheme's promised national portability, particularly affecting the thousands of migrant workers who rely on the program outside their home states.
A senior Delhi government health official acknowledged that the problem often originates from state-level restrictions within Ayushman Bharat. "Some states reserve certain treatments exclusively for their own government hospitals. Consequently, those treatment packages may not appear available to private hospitals in another state because the financial claim is ultimately paid by the patient's home state," the official explained.
However, the official emphasized that hospitals are strictly prohibited from denying treatment solely because a patient's Ayushman card was issued by another state.
Official Stance Versus Ground Reality
Officials from the National Health Authority (NHA), which administers PMJAY, reiterated that the scheme explicitly allows beneficiaries to seek treatment at any empanelled hospital across India. "Private hospitals cannot legally deny treatment on the grounds that the card originates from another state. If a specific medical procedure is not covered under the empanelment, they may communicate this limitation—but refusal based purely on card origin is categorically prohibited," stated an NHA representative.
Patients encountering such denials can contact the toll-free helpline 14555, which triggers an SOS grievance mechanism typically resolved within five hours. Yet for many like Divya's family, this theoretical recourse offers little comfort during medical emergencies.
Hospital Concerns and Financial Disincentives
Dr. Narin Sehgal, Delhi state secretary of the Association of Hospitals Organisation, highlighted several systemic issues discouraging private hospitals from enthusiastically participating in PMJAY. These include perceived low package rates under the scheme, significant delays in reimbursement payments, arbitrary claim deductions, and what hospitals describe as an ineffective grievance redressal mechanism.
"Patients from other states are particularly vulnerable to these systemic flaws," Dr. Sehgal noted. "Payments for their treatments often remain pending for extended periods, creating financial disincentives for hospitals to accept out-of-state Ayushman cards."
Statistical Context and Implementation Challenges
Delhi formally joined the PMJAY framework in April 2025. Since that integration, 984 patients from Delhi have received treatment in other states, with claims totaling approximately Rs 2.5 crore paid up to November 14. Nationally, since the scheme's inception in 2018, around 160,000 out-of-state patients have been treated in Delhi hospitals, with their combined claims amounting to Rs 907 crore.
These substantial numbers underscore both the scheme's significant reach and the critical importance of resolving portability issues. For beneficiaries like Divya's family, the chasm between theoretical entitlement and practical access can mean the difference between timely medical relief and life-threatening risk.
"We possessed the card that promised protection," Divya reflected. "But when we needed assistance most urgently, only a government hospital ultimately provided the necessary care. This experience revealed that the promised safety net has dangerous gaps that must be addressed."
