Step 1: Decide whether it is a hospital problem or claim problem
A hospital problem includes cash demand, bed denial, refusal of authorised treatment, poor service, negligence or substandard treatment. A claim problem occurs after you have paid and submitted reimbursement documents—such as a returned claim, deduction, missing-document remark or pending claim. The escalation route is different.
Step 2: If an empanelled hospital asks for cash or refuses service
ECHS currently instructs beneficiaries to bring difficulty at an empanelled hospital to the Director Regional Centre immediately. Record the hospital, department, date/time, person spoken to, amount demanded and referral/authorisation details. Obtain a written demand/bill where possible, but do not share an OTP or surrender original documents without acknowledgement.
Step 3: Check whether the planned treatment was properly authorised
Verify current empanelment, the speciality, referral validity and whether the procedure/admission required separate approval. A hospital cannot fix an invalid or incomplete referral by asking the beneficiary to pay first. Contact the referring polyclinic/Regional Centre when authorisation is disputed.
Step 4: If you paid in an emergency or non-empanelled setting
Preserve emergency records, admission/discharge papers, prescriptions, investigations, itemised bills, receipts and payment proof. Follow the ECHS emergency/reimbursement route promptly. Reimbursement is governed by admissibility and applicable ECHS/CGHS rates; the full private-hospital bill is not automatically reimbursable.
Step 5: If a submitted claim is pending or returned
Open the official Claim Status service, note the exact remark and keep the Claim ID. Supply only the clarification/document requested through the prescribed route. Do not submit a duplicate claim simply because the original is taking time.
Step 6: If the claim is rejected or an amount is deducted
Read the rejection/deduction reason first. Compare it with the referral/emergency entitlement, bills, discharge summary, prescriptions, approvals and applicable rates. Prepare a point-by-point representation with the Claim ID and supporting documents. Use the concerned Regional Centre/Jt Director (HS)/Director Regional Centre route as applicable.
Step 7: Keep a complete evidence packet
Keep copies of the ECHS card/entitlement, referral or emergency intimation, authorisation, hospital record, prescriptions, investigation reports, discharge summary, itemised bills, receipts, payment proof, Claim ID, status screenshots and every earlier email/letter. Send copies unless the official procedure specifically requires originals.
Step 8: Escalate safely and in sequence
For an active empanelled-hospital service problem, contact the Director Regional Centre immediately. For reimbursement, follow the concerned Regional Centre/medical-claims route and attach the Claim ID and earlier response. If still unresolved, use the official ECHS grievance/escalation route with the full chronology. ECHS does not specify one fixed disposal time for every hospital or claim complaint.