Srinagar, Jun 9: In a development that could significantly impact healthcare access for thousands of beneficiaries across Jammu and Kashmir, private hospitals and dialysis centres empanelled under the Ayushman Bharat–SEHAT Scheme have announced their proposed de-empanelment from the flagship health insurance programme with effect from July 1, 2026, citing prolonged delays in reimbursement of claims and alleged non-compliance with National Health Authority (NHA) guidelines.
The announcement was made by the J&K Private Hospitals & Dialysis Centres Association (JKPHDA), which said the continued non-payment of legitimate claims has placed severe financial and operational strain on healthcare institutions across the Union Territory, threatening their ability to sustain quality medical services under the scheme.
A spokesperson of the Association said repeated representations to the concerned authorities have failed to yield results, while payments to empanelled private hospitals and dialysis centres have remained pending for extended periods.
JKPHDA said private healthcare institutions provide a range of critical services, including dialysis, intensive care, emergency treatment, surgeries, oncology care, cardiac interventions and trauma management, all of which require uninterrupted availability of medicines, consumables, skilled healthcare personnel and well-maintained medical equipment.
“Extended delays in reimbursement, coupled with the rejection or deduction of claims without an effective review mechanism, have created considerable difficulties for healthcare providers. While our primary commitment remains the welfare of patients, sustaining the required standards of care is becoming increasingly challenging,” the Association said.
The Association also linked the crisis to rising global healthcare costs, stating that the ongoing conflict in the Middle East has disrupted supply chains and increased the prices of several critical medical products. According to JKPHDA, the situation is particularly serious in oncology services, where the availability and pricing of essential cancer medicines such as Cisplatin and Carboplatin have been adversely affected.
It said prolonged delays in reimbursements have made it difficult for private hospitals to maintain adequate stocks of these medicines. Similar challenges are being faced in cardiology and orthopaedics, where procurement of cardiac stents and orthopaedic implants requires substantial working capital.
The Association warned that continued withholding of payments has constrained the ability of private healthcare institutions to procure life-saving and life-enhancing medical products, potentially affecting patient care and placing additional pressure on healthcare providers.
JKPHDA further claimed that while private hospitals continue to face delayed reimbursements, more than Rs 180 crore of Ayushman Bharat funds are reportedly lying unutilised with public hospitals in Jammu and Kashmir.
“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 clearly segregated and streamlined to promote transparency, accountability and timely disbursement of funds,” it said.
The Association also expressed concern over what it described as restricted access to certain procedures under the scheme. It claimed that surgeries such as gall bladder removal and haemorrhoidectomy are increasingly being performed only in public hospitals, where waiting periods have reportedly stretched beyond ten months in several cases.
Raising concerns over contractual obligations, JKPHDA said delays in claim settlements are inconsistent with timelines prescribed under NHA guidelines and the provisions governing the scheme. Referring to the Memorandum of Understanding signed under the programme, the Association said empanelled institutions are entitled to receive one per cent interest per week on delayed payments under Section 6 of the MoU, but have not received the same despite prolonged delays.
In view of the prevailing situation, private hospitals and dialysis centres across Jammu and Kashmir have resolved to initiate de-empanelment from the Ayushman Bharat-SEHAT Scheme from July 1 unless immediate corrective measures are taken.
The Association demanded immediate settlement of all pending claims along with applicable interest, a transparent and time-bound mechanism for reviewing rejected or deducted claims, strict adherence to NHA guidelines, segregation of payment procedures for public and private hospitals, restoration of patient choice, and immediate engagement with private healthcare providers to address operational concerns.
JKPHDA reiterated that private healthcare providers remain committed to serving the people of Jammu and Kashmir and continue to support the objectives of the Ayushman Bharat-SEHAT Scheme. However, it cautioned that quality healthcare services cannot be sustained indefinitely without timely reimbursement of claims.
“The present situation threatens the continuity of services for thousands of beneficiaries who depend on private hospitals and dialysis centres for critical healthcare,” the Association said, urging the J&K administration, State Health Agency and concerned authorities to intervene urgently and resolve the issue in the larger public interest.
