Cashless & TPA

• In the case of planned admissions, the patient needs to submit the required documents as given below to the TPA help desk at least 2 days prior to the date of admission.
•  The preauthorization form has two parts:
– General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
– Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
• The following documents are required to be submitted:
– Insurance ID Card
– Consultation/Prescription paper or Doctor Advise for admission.
– Any Relevant Investigations reports  supporting the diagnosis
– Photo Id  and address proof of the patient
– Recent passport size photo of the patient
• The TPA help desk will be sending these documents to your TPA/insurance company for further processing.
• The TPA/insurance company can revert with either of the following:
Initial Approval – The same will be alerted to you by a phone call
Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a telephone call

• In the case of emergency admission, it is our priority to start the patient treatment at the earliest.
• The cashless process has to be initiated within 24 hrs of the admission.
• The patient needs to pay a deposit at the time of admission (as per hospital policy based on a type of surgery or class of admission) and that will be refunded to the patient as per the hospital refund policy for the cashless patients.
• The preauthorization form has two parts:
– General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
– Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
• Along with this additional documents are required to be submitted which are as follows:
– Insurance ID Card
– Consultation/Prescription paper or Doctor Advise for admission.
– Any Relevant Investigations reports  supporting the diagnosis
– Photo Id  and address proof of the patient
– Recent passport size photo of the patient
• The TPA help desk will be sending these documents to your TPA/insurance company for further processing.
• The TPA/insurance company can revert with either of the following:
– Initial Approval – The same will be alerted to you via a phone call.
– Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a phone call.

• If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the TPA helpdesk to the TPA / insurance company. However, if no enhancement is received from the TPA / insurance company, the patient will have to pay for the bill amount over and above the sanctioned amount.
• If the TPA / Insurance Company intimates that the Sum insured is exhausted the patient needs to pay for the bill amount above the exhausted amount. The discharge process will however be as a TPA/ Insurance patient.
• Receiving an authorization letter for Cashless hospitalization is only tentative. The TPA/Insurance Company can deny the claim for any reason during the course of treatment or after a patient is discharged. The patient will be responsible for payment of the hospital bills, as per the undertaking which the hospital collects at the time of registration under respective TPA / Insurance Company.
• At all stages the information will be shared with you via phone calls.

• On the day of discharge the patient’s final bill and discharge summary will be sent to the respective TPA / Insurance Company and it will take maximum 4 to 6 hours to process the final Approval from your respective TPA / Insurance Company.
• On receiving the final approval the patient’s discharge will be completed after taking the refundable deposit on sanctioned amount as a security deposit until the hospital receives complete payment from the TPA / insurance company
• Patient is required to pay for all non-payable expenses as their policy does not cover the non-payable expenses
• No original documents or reports of the hospitalization will be given to patient, since these are to be sent by the hospital to TPA / insurance company along with the final bill for the final payment.
• At the time of Discharge, the patient can collect a copy of final bill from the Billing department.
• A photocopy of all the reports along with any pending reports can be collected from the Report Counter after 7 days of discharge.