3 accidents a day, but just 8 cashless claims a month: Where's relief scheme going wrong?

GHAZIABAD: Ghaziabad reported an average of three accidents every day in the first four months of the year, but only 40 claims have been received under the Centre's PM-Rahat scheme, which provides up to Rs 1.5 lakh in cashless treatment for accident victims, in the five months since it was operationalised in May, averaging eight claims a month.The number points to shortcomings in the way the scheme is being implemented, which assume significance after a 24-year-old accident victim who was seriously injured in a road accident and could not get the level of treatment he needed at a PM Rahat empanelled hospital, died this week.Tushar Kumar's father has alleged his son lost vital time because of a delay in treatment. Tushar was taken to a second hospital, Yashoda Medicity, which is not empanelled and where the father claimed he was asked to clear a bill of Rs 48,000 for Tushar to be released so that he could be moved to Safdarjung Hospital in Delhi.Gautam Budh Nagar's PM- Rahat claims are higher at 149 in the same period (an average of 30 a month), but still very low when compared to accident numbers. According to traffic police data, the city recorded 577 road accidents between Jan and July this year, claiming 450 lives.Officials said a mix of low public and institutional awareness, procedural bottlenecks and uneven hospital empanelment were coming in the way of the ultimate intention - of saving accident victims' lives within the golden hour.What is the scheme?The PM Road Accident Victims' Hospitalisation and Assured Treatment scheme was notified by the highways ministry to ensure that financial constraints do not delay emergency treatment for anyone during the crucial 60 minutes - also referred to as the "golden hour" - immediately following a traumatic injury, when prompt medical and surgical treatment gives the highest likelihood of saving a life.It covers motor vehicle accidents on any category of road and provides cashless treatment of up to Rs 1.5 lakh per road accident victim for a maximum of seven days from the date of the accident. Much of the network of hospitals under the scheme has been built around hospitals already empanelled under Ayushman Bharat scheme.According to official guidelines from Ministry of Road Transport & Highways, the scheme automatically covers all 36,112 hospitals empanelled under Ayushman Bharat (PM-JAY). In Noida, the scheme covers all 61 hospitals under Ayushman Bharat, while in Ghaziabad 86 are empanelled. Health officials told TOI all AB-PMJAY empanelled hospitals that provide the requisite trauma, polytrauma and stabilisation services in compliance with National Health Authority (NHA) guidelines are deemed designated hospitals for cashless road accident treatment.How to avail scheme?The process is designed so that victims or their families do not have to arrange money or complete lengthy paperwork before emergency treatment begins. A victim, bystander or family member can call Dial 112, the emergency response support system, which is integrated with PM-Rahat and can provide ambulance assistance and information about the nearest empanelled hospital. Police responding to an accident can also access the list of empanelled hospitals.Once the victim reaches a designated hospital, treatment begins under the approved health benefit packages. The hospital generates a treatment ID on the NHA's transaction management system (TMS) and sends details to police through the electronic detailed accident report (eDAR) system for verification.Police authentication runs alongside treatment and is not a prerequisite for the hospital to begin emergency care. Police have up to 24 hours to respond through eDAR, or up to 48 hours in cases the hospital administrator classifies as life-threatening. The system creates a digital trail from the accident report through admission, treatment, police verification, claim processing and payment.Who can avail scheme?Officials said the scheme is not restricted to people who hold an Ayushman Bharat card. PM-Rahat is a separate statutory scheme for victims of road accidents involving motor vehicles, and it covers people irrespective of the insurance status, with the reimbursement mechanism varying by circumstances. "At the time of billing, if a patient has Ayushman Bharat, or any other private insurance, they can avail those. However, if one does not have any insurance, then the PM-Rahat scheme can be used," the official said.Ghaziabad health department nodal officer (road safety) Dr Pankaj Rakesh said the district had taken steps to ensure that police and emergency responders know where designated hospitals are located. "Information about the empanelled hospitals, including their names and locations, has been shared with police officials at different levels, including police stations and senior officers, as well as emergency service providers. The objective is to ensure that once an accident is reported, the responding personnel can quickly identify the nearest PM-Rahat empanelled hospital and arrange for the victim to be shifted there without losing critical time," Rakesh said.He added that lists of empanelled hospitals were also being made available at key points on the highway network.Denial of admission or treatment under PM-Rahat amounts to non-compliance with the scheme and can attract punitive measures under the Clinical Establishments (Registration and Regulation) Act, 2010, or the corresponding state-specific laws.States and UTs can take action under applicable laws, while the empanelment framework also provides for disciplinary action, suspension and de-empanelment.Why uptake is low?Strict digital deadlines, patchy hospital empanelment and early-stage system gaps have affected the uptake and reimbursement process. A victim can become ineligible for the scheme's benefits if hospitalisation occurs more than 24 hours after an accident. Police also need to authenticate claims within 24 hours for non-life-threatening injuries and 48 hours for life-threatening ones, or an application can be rejected. Some empanelled hospitals still turn patients away or demand upfront payment, fearing delayed reimbursement. According to health department data, 679 claims were approved since rollout, while 168 were rejected after no response was received from the police within the prescribed timelines. Another 40 life-threatening cases were found ineligible under the scheme by the police. Under the scheme, cases classified as life-threatening by the hospital administration remain eligible for treatment until the case is rejected by the police through e-DAR or until 48 hours have elapsed, whichever is earlier.You Can Also Check: Gold Rate in Ghaziabad | Silver Rate in Ghaziabad | Bank Holidays in Ghaziabad | Public Holidays in Ghaziabad | Ghaziabad AQI | Weather in Ghaziabad | Petrol Price in Ghaziabad | Diesel Price in Ghaziabad | CNG Price in Ghaziabad | LPG Price in GhaziabadStay updated with the latest Ghaziabad news. Download the TOI App.