Kohima, April 17 (MExN): The Nagaland Health Protection Society (NHPS) today made an “earnest appeal” to all Private Empanelled Health Care Providers (EHCPs) in the State to continue provision of services under the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana – Chief Minister’s Health Insurance Scheme (AB PM-JAY CMHIS).
The Department is undertaking all efforts to resolve the non-payment issue, stated a press release from NHPS, amid an announcement by the Nagaland Private Doctors’ Association (NPDA) that all private EHCPs would be suspending AB PM-JAY CMHIS services from April 17.
NHPS stated that the Department is making all efforts to resolve the payment impasse.
In the meantime, beneficiaries have been advised to seek treatment at Government hospitals or the Christian Institute of Health Sciences and Research (CIHSR), which will continue to provide uninterrupted and cashless services.
Reaffirming its commitment to ensure timely and quality healthcare, NHPS said the claim settlement process is being actively pursued, and indicated that the insurer – Future Generali India Insurance Company (FGI) -will be held accountable.
For assistance, beneficiaries may contact the NHPS helpline at 1800-202-3380.
Points finger at insurer
According to the NHPS, the prolonged delay in settling legitimate claims by FGI, the insurer of the AB PM-JAY CMHIS scheme, has created growing operational and financial challenges for empanelled hospitals.
Providing the outstanding claims status, the NHPS informed claims worth Rs178.96 crore were submitted under scheme as of April 14, 2025.
Of this, Rs 147.65 crore were approved by FGI, but only Rs 99.28 crore disbursed. Claims worth Rs 48.81 crore are pending, while Rs 8.40 crore were rejected, it added.
NHPS attributed the crisis to delayed payments by FGI and alleged that concerns raised by the insurer over “fraudulent claims” lacked evidence.
An internal review found most flagged claims to be genuine or already under investigation. Despite offering joint verification, FGI reportedly remained unresponsive, it added.
The withholding of payments, NHPS said, breaches contract provisions and the National Health Authority (NHA) guidelines, as the alleged frauds have not been proven beyond reasonable doubt.
While reiterating the State Government’s support for recovering fraudulent claims and punishing erring hospitals, NHPS criticised the blanket suspension of payments by FGI.
The full premium amounting to Rs 91.99 crore has already been paid to the insurer, it underscored.
Seeking regulatory and legal recourse
To this end, the NHPS informed that the matter has been formally bought to the attention of Insurance Regulatory and Development Authority of India (IRDAI), National Health Authority (NHA), and the Department of Financial Services (DFS), Ministry of Finance, Government of India.
All relevant documents, including claim statuses, have been submitted for intervention, it said.
The Society added that two hospitals have already been suspended and recovery initiated from two others.
NHPS is also examining legal and contractual options to ensure compliance with the agreement signed with FGI, it added.
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