Swasthya Sathi
Hospital revenue integrity in West Bengal.
A state scheme covering the whole population by household, with its own empanelment and package structure independent of PM-JAY.
Cities in West Bengal
Reading
How the scheme actually works here
Swasthya Sathi covers the population by household and runs its own empanelment and package structure independent of PM-JAY. Hospitals commonly carry it alongside private insurance rather than instead of it.
The payer mix in West Bengal
Kolkata runs a large tertiary sector serving the whole eastern region. Siliguri is the gateway for north Bengal and much of the Northeast, which brings out-of-state eligibility complexity.
Where hospitals here lose money
Oncology volume in Kolkata runs into per-cycle sub-limits that compound across a course.
Tertiary neurology and oncology stays outrun initial approvals routinely.
Patients arriving from other states need eligibility established before treatment, and the referral chain is longer than a local desk expects.
Check this week
For recurring-treatment patients, track sessions against approval balance rather than against date. A calendar reminder fires whether or not the patient attended.
What does not change at the state border
Room-rent proportionate deduction, pre-authorisation notification clocks, tariff drift against contract, and package-with-component billing work identically in West Bengal and everywhere else in India. They vary by contract, not by geography. What the state changes is the scheme layer sitting on top — which cases are viable, and what evidence the payer expects.
Worked through in detail: the nine ways an Indian payer reduces a claim, how scheme claims differ from private ones, and the ₹8,000 upgrade that costs ₹43,000.
Cities we cover in West Bengal
Questions from West Bengal
Does Drapto work with Swasthya Sathi in West Bengal?
Yes. Package rates are held per scheme, so a case can be checked for viability before admission rather than at billing. Swasthya Sathi covers the population by household and runs its own empanelment and package structure independent of PM-JAY.
What do hospitals in West Bengal lose the most money to?
Day-care chemotherapy sub-limits. Oncology volume in Kolkata runs into per-cycle sub-limits that compound across a course.
Do the payer rules change between states?
The scheme layer does — package lists, empanelment and eligibility are state-specific. The mechanics underneath do not. Room-rent proportionate deduction, notification clocks and tariff drift work identically everywhere in India; they vary by contract, not by geography.
Is Drapto available across West Bengal?
Yes, anywhere in the state. Deployment is remote and takes one to five weeks depending on size, with your payer tariffs loaded before go-live rather than after.
What does the free audit involve?
Twenty claims you have already settled. We show what was disallowed, how much was predictable, and how much the payer never explained. About an hour of your team's time, and you keep the findings whatever you decide.
Read next
The scheme changes at the state border. The payer mechanics do not — room caps, notification clocks and tariff drift work the same way in West Bengal as everywhere else.
Every way an Indian payer reduces a claim →
Other states
Read next
What is not on this page. We do not publish hospital directories, rank hospitals, or list which facilities sit on any insurer’s or scheme’s panel. Empanelment is product-specific and changes constantly — a stale list published by a third party sends a family to a hospital believing they are covered when they are not.
Your Insurance Ombudsman
For repudiated claims in West BengalA repudiated cashless claim here is generally heard by the Kolkata office, broadly covering West Bengal; Sikkim. Filing costs nothing and needs no lawyer, but there is a one-year clock from the insurer’s final reply.
Jurisdiction is defined by district in several states. Confirm yours against the Council for Insurance Ombudsmen’s list before filing.
The scheme you actually bill
West Bengal| State scheme | Swasthya Sathi |
| Alongside | Ayushman Bharat PM-JAY, private insurers and TPAs |
| Why it matters here | State-run. West Bengal has not implemented PM-JAY in the usual form. |
Tariffs are held per payer and per contract in Drapto, so a claim is never priced under the wrong one.
Verify before you rely on this. State schemes are renamed and revised with budgets and governments. Check the current position with the state health agency.
See it on your own claims.
The payer mix is local. The mechanism is not — and it is the mechanism we show you.