We all buy health insurance, hoping it will be there when we need it the most. But what happens when, despite having coverage, help just doesn’t come? That’s exactly what unfolded in one recent case, which has now sparked a wider conversation. This is the story shared by Divya Unni Films in a video about her father, who worked at SBI for over 40 years and had bought health insurance, believing it would support him in emergencies. Yet, at the age of 80, he found himself struggling to get the care he needed.
What Went Wrong in Her Case
In her video, Divya shared that her father was admitted to a hospital in Mulund, Mumbai, early in the morning on 29th July. Starting from 6 am, she began reaching out to all 24 hospitals listed under the Ayushman Bharat scheme across Mumbai, Navi Mumbai, and Thane, searching for one that would accept her father’s treatment.
For context, she explained that her father had two health insurance policies—one private and one under Ayushman Bharat, the government-backed scheme. The government insurance was taken as a backup plan, especially considering his age. The idea was that if the private insurance didn’t cover certain expenses, they could rely on Ayushman Bharat.
However, that backup plan failed them too. She called the hospitals one by one. To her shock, 10 hospitals outright denied being empaneled with the scheme and refused treatment. Another five or six hospitals were unreachable—calls went unanswered or didn’t connect.
The hospitals that did respond revealed a confusing reality: the scheme only covers specific conditions at specific hospitals. For example, Jupiter Hospital in Thane accepts claims only for oncology treatments, while Apex Hospital in Ghatkopar covers only critical care cases. This left her stunned and frustrated.
Divya said she had always thought health insurance was straightforward—either you get cashless treatment covered by your insurer, or you pay upfront and get reimbursed later. But in her father’s case, neither option worked.
Forced to pay the medical bills herself, what troubled her most was that despite being educated and financially aware, she struggled to navigate this system. It made her wonder how vulnerable families—the very people the scheme is meant to help—manage in a healthcare crisis.
Her frustration was clear as she ended her video by asking, “Has this card worked for anyone yet?” She also highlighted the scheme’s promise of coverage up to ₹5 lakh but said the reality felt very different.
But What Exactly Is the Ayushman Bharat Scheme?
Ayushman Bharat is a flagship government health program launched in 2018 to provide universal health coverage. One of its key components, the Pradhan Mantri Jan Arogya Yojana (PMJAY), offers up to ₹5 lakh per family per year for hospitalization in public and empaneled private hospitals across India.
The scheme mainly covers:
Rural families: Households with no adult members aged 16–59, landless families, and those without a regular source of income.
Urban poor: Street vendors, domestic workers, rickshaw pullers, and laborers in unorganized sectors.
Vulnerable groups: Elderly persons, widows, orphans, differently-abled individuals, and those listed under the SECC category.
Importantly, all senior citizens aged 70 and above are eligible regardless of income or socioeconomic status.
The scheme provides cashless treatment at the point of service, covering hospitalization costs along with 3 days of pre-admission and 15 days post-discharge expenses. This includes diagnostics, medicines, doctor fees, surgery, room charges, ICU care, and more—with no cap on family size, age, gender, or pre-existing conditions.
Public Reaction and the Indian Medical Association Report
After Divya’s video gained attention, it sparked a wide range of reactions online. Many people echoed her experience, sharing how they, too, struggled with reimbursements. Some said they never received any payment, while others got far less than the promised ₹5 lakh coverage—sometimes only a few thousand rupees.
However, several users claimed the scheme worked well for them, especially in states like Gujarat and Uttar Pradesh, and in smaller tier 2 and tier 3 cities. This contrast highlighted how the Ayushman Bharat experience can vary greatly depending on location.
One comment also cited the Indian Medical Association (IMA), which noted that many hospital bills under the scheme remain unpaid or delayed. These delays discourage some hospitals from participating fully, affecting beneficiaries’ access to care.
Divya’s Follow-Up Video
In response to these varied reactions, Divya posted a follow-up video, acknowledging that while the scheme seems effective for many in smaller cities, it didn’t work for her family—and others in Mumbai shared similar experiences.
She pointed out a clear gap between the scheme’s provisions and how it is implemented on the ground. She also said this problem isn’t unique to Ayushman Bharat; people reported struggles with both government and private insurance schemes.
Divya expressed disappointment that the systems designed to support patients often fail when families are already under stress. She questioned how an average person, coping with a loved one’s illness, can also navigate these complex challenges.
She ended by saying that as a taxpaying citizen, she expects at least a reliable healthcare support system from her government.
Final Thoughts
Divya’s experience serves as a reminder that while Ayushman Bharat has brought relief to many, challenges remain in ensuring smooth implementation across the board. The mixed reactions to her video highlight how the scheme’s effectiveness can vary depending on location, hospital participation, and procedural clarity. Strengthening these areas could help bridge the gap between policy intent and public experience.
This leaves an important question for the public: Is the scheme truly reaching everyone it is designed to help, or is there still more work to be done?
(Rh/Pooja Bansal/MSM/SE)
