Insurance
Cashless & TPA
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Ayush Agarwal
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Cashless Process
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Patient Process
Cashless Process
The patient is required to fill up a pre-authorization form before admission. You are requested to check your insurance card/insurance policy (or speak to your insurance agent) about the TPA before downloading and filling the form. (Forms are available on our website)
The patient must give a true medical history to the doctor at the time of filling in the pre-authorization form to avoid any discrepancy which may result in the denial of the claim and cancellation of the approval in the future.
• 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.
Patient Process
Reimbursement Process
For patients who do not avail the benefit of Cashless hospitalization or whose claims are denied for Cashless, they can do the following process:
| Patient | Doctor | Hospital |
Before admission | Inform the insurance/TPA company(Planned cases – In advance) (emergency case – within 24 hours for hospitalization) |
|
|
At Discharge | Fill the Reimbursement Form* Fill the request form for Indoor case paper | Fill the Doctors part in the Reimbursement form | Fill the Hospital details and provide the sign and stamp in the Reimbursement form# |
After Discharge | Collect the Indoor case papers from the Medical records department |
|
|
* Please collect the form from your agent or the TPA/Insurance Company
# Timing – between 9:00 am to 5:00 pm from Monday to Saturday only
Kindly check with your TPA/Insurance Company regarding the requirement of a minimum duration of hospitalization of 24 hours for eligibility of your insurance claim
