ENT Treatment Under Ayushman Card in Gurgaon

What is Ayushman Bharat PMJAY?

PMJAY is the Government of India's health insurance scheme. Eligible families get cashless cover of up to ₹5 lakh per family per year for hospital treatment in empanelled hospitals. Senior citizens aged 70 and above are also eligible under the scheme's extension, irrespective of income. Treatment is covered under fixed "packages" decided by the National Health Authority, which list the procedures and what they include.

ENT treatment under Ayushman card

Many common ENT surgeries are part of PMJAY packages. These include, among others:

• Tonsillectomy and adenoidectomy
• Septoplasty and endoscopic sinus surgery (FESS)
• Tympanoplasty and mastoid surgery
• Removal of nasal polyps
• Thyroid and salivary gland surgery (see head and neck surgery)
• Some procedures for children, such as grommet insertion

Whether a specific procedure is covered for you depends on the current PMJAY package list and the approval process. The Ayushman desk at the centre checks this for each patient.

How the process works

• Step 1 – Consultation: Dr. Sahil Kapoor examines you and advises tests if needed.
• Step 2 – Eligibility check: the Ayushman desk verifies your card or eligibility using the PMJAY system.
• Step 3 – Pre-authorisation: if surgery is advised and the procedure is covered, the hospital sends a request for approval to the scheme.
• Step 4 – Treatment: after approval, the procedure is done as a cashless treatment under the package.
• Step 5 – Discharge and follow-up: you get your discharge summary and follow-up instructions.

Documents to bring

• Ayushman card / e-card, or the details used to check eligibility
• Aadhaar card of the patient
• Ration card or family ID, if asked
• Previous prescriptions, test reports and scans

Bringing these on your first visit saves time. If you don't have a card yet but think you may be eligible, the desk can guide you on how to check.

Other insurance and ECHS

The centre is also empanelled with ECHS and several private insurers and TPAs. For planned surgery, bring your insurance card and policy details so cashless approval can be requested in advance. If cashless treatment is not available under your policy, you can usually claim reimbursement later. Keep all original bills and reports for this.

Other departments at K.K. Health Care Centre

Apart from ENT, the centre offers general and laparoscopic surgery (gallbladder, hernia and appendix), urology (kidney stones and prostate), orthopaedics, gynaecology and diagnostic services such as X-ray and ultrasound. Please ask at the centre for details of the doctors and services in these departments.

Frequently Asked Questions

Is ENT surgery covered under Ayushman card?

Many ENT surgeries are covered under PMJAY packages, including tonsillectomy, septoplasty, sinus surgery and tympanoplasty. Coverage for your case is confirmed after consultation and pre-authorisation.

Is OPD consultation covered under Ayushman card?

PMJAY mainly covers hospitalisation and procedures. Rules for OPD consultations and tests may differ, so please check at the desk.

How long does Ayushman approval take?

Pre-authorisation is often approved within a day or two, but it depends on the case and the scheme's process.

My family member is above 70. Are they eligible?

Senior citizens aged 70 and above are eligible under the scheme extension. The desk can help check and create their card.

Can I use private insurance instead?

Yes. The centre works with several private insurers and TPAs. Bring your policy details for a cashless request.

Contact

Ace ENT Care, K.K. Health Care Centre, 238, Sector 5, Gurugram, Haryana 122001. Phone: +91-8178774813. For eligibility, documents and appointment details, call the centre or use the appointment page.