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Lokpriya Hospital
"Compassionate care at affordable price"

BEL : BHARAT ELECTRONICS LIMITED

CGHS : CENTRAL GOVERNMENT HEALTH SCHEME

CWC : CENTRAL WAREHOUSING CORPORATION

ECHS : EX SERVICEMEN CONTRIBUTORY HEALTH SCHEME

UPPCL : UTTAR PRADESH POWER CORPORATION LIMITED

APOLLO MUNICH

BAJAJ ALLIANZ LIFE INSURANCE

HDFC ERGO GENERAL INSURANCE COMPANY LIMITED

ICICI LOMBARD LIFE INSURANCE

KOTAK LIFE INSURANCE

MAX BUPA LIFE INSURANCE

RELIANCE GENERAL INSURANCE COMPANY LIMITED

STAR HEALTH LIFE INSURANCE

UNIVERSAL SOMPO GENERAL INSURANCE COMPANY LIMITED

ERICSON TPA HEALTHCARE PVT. LTD.

FAMILY HEALTH PLAN (TPA) LTD.

GENINS INDIA TPA LTD.

HEALTH INDIA TPA SERVICES PRIVATE LIMITED

ICICI LOMBARD TPA SERVICES (I) PVT. LTD

MD INDIA HEALTHCARE (TPA) SERVICES (PVT.) LTD.

MEDICARE TPA SERVICES (I) PVT. LTD.

RELIGARE TPA SERVICES (I) PVT. LTD

STAR HEALTH TPA SERVICES (I) PVT. LTD

UNITED HEALTHCARE PAREKH TPA PVT. LTD.

VIPUL MED CORP TPA. PVT. LTD.

VIDAL TTK HEALTHCARE TPA PVT. LTD

CIGNA TTK

PARAMOUNT HEALTH CARE

MEDSAVE HEALTHCARE

ANNUALLY HEALTH CHECK-UP-BANKERS

ALLAHABAD BANK

ORIENTAL BANK OF COMMERCE

PUNJAB NATIONAL BANK

SYNDICATE BANK

UNION BANK

ARCOFEBBI HEALTHCARE

JUBILANT LIFESCIENCES

MAWANA SUGAR MILL

OUR HEALTH MATE

DAURALA SUGAR MILL

INDO RUBBER PVT LTD

NANGLAMAL SUGAR MILL

TITAWI SUGAR MILL

GUIDELINES FOR CASHLESS TREATMENT UNDER HEALTH INSURANCE POLICY

The essence of cashless Hospitalization is that the insured individual need not make any upfront payment to the designated/empanelled hospital for treatment. To avail cashless banefit without any inconvenience you need to go through the following :-

1. Empanelment of Hospital

Before admission please confirm with our admission desk/Medical insurance desk whether your insurance company/TPA is registered with us.

2. Pre Requisite for Admission

At the time of admission it is mandatory to produce the following documents issued by your insurance company/TPA at our admission desk

→ Valid TPA/Insurance card

→ Proof of identity

→ Policy documents

Immediately after admission of the patient ,his/her next kin should contact our Medical insurance /TPA Deskfor sifning pre-authorisation form and submission of the following documents:Doctor’s advice for admission, ID card issued by TPA/Current Policy Papers etc as may be required

3. How are Claim processed

Processing of a health Insurance claim is time taking and you are requested to please bear with us. The following is an over view of the claim process:

Step 1: Patient presents for admission

Step 2: Filling up of the Pre Authorisation form by treating doctor and sending to TPA / Insurance company concerned and waiting for initial approval. The estimated amount of expenditure is mentioned there

Step 3: TPA/Insurance company may revert back with queries if any which are replied by the hospital

Step 4: TPA/Insurance company sends provisional approval as per patients policy etails

Step 5: Patient is allowed to undergo treatment at the hospital as per approval

Step 6: Prior to discharge the final bill , treatment details & the discharge summary of the patient is sent to the TPA/Insurance company for final approval

Step 7: TPA/Insurance company may have multiple queries which have to be replied to by the hospital. Approval is not sent till all queries have to be answered and the TPA /Insurance company is totally convinced that treatment has been done as per approval

Step 8: After final approval is received the patient is clear for discharge

4. Follow up during the period of hospitalization

During the perioed of treatment , the patient’s kin should keep liaison with our TPA DESK on a regular basis to know the development. Your insurnace company /TPA may send queries for which our executive may not need your help to reply to

5. Important:When can you be asked to pay even if you have cashless insurnce policy.

It is our endeavor to provide cashless benefit to our insurance patients but due to many a reason the same may not be possible at times. You may be requested to make payments in the following situations:

→ Denial of your claim by the insurance company /TPA . Hospital will not be responsible for such denial and in that case the patient will have to clear the hospital dues before dischrge of the patient

→ The TPA/Insurance company may pay a part of the total bill. In that case the patient will have to settle the balance amount prior to discharge. Youer policy may mention for a Co-Payment clause wherwein the beneficiary will have to pay a part of the bill

→ Most health insurance companies/TPA have adopted a system of capping on bed charges to 1% of the policy amount. If the beneficiary avails any facility beyond his/her entitlement then he/she will have to pay the difference amount to the hospital prior to discharge

→ Your health insurance company/TPA does not pay for everything . Certain expenses like service charge, cost of diaper, hand gloves,extra food, telephone bill, nutritional supplements etc are to be paid by the patients. These are called as NON ADMISSIBLE EXPENSES . Please refer to the annexure to know the common list of such non admissible expenses that you may have to pay for. For a detailed list of exclusions please refer to your policy document.

6. Discharge Process

As per the system adopted by most health insurance company /TPA’s the final sanction is ent only after getting the discharge summary and the Final Bill . Hence even after the discharge advice of the doctor , patient may have to stay in the hospital for further few hours till such sanction is received by the hospital

7. Planned Admission

For any planned treatment (surgery) it is advisable to get approval for cashless benefit from your health insurance company/TPA before the patient is admitted in the hospital. To get such approval please contact our medical insurance/TPA DESK with following documents: Doctor’s advice for admission, ID Card issued by your health insurance/TPA , Current policy documents, all reports of investigations done to determine the treatment

8. Emergency Admission

In case the patient is admitted under emergency conditions then the required documents must be submitted within 24 hrs of admission. Hospital will not be responsible for denial of claim by your insurance company/TPA due to delayed submission of documents

9. Insurance /TPA Help Desk

In case of any assistance or queries regarding your claims processing please feel free to contact our Insurance/TPADesk on the ground floor (9:00 AM to 6PM)

Lokpriya Hospital is empanelled with the following PSU’s, Insurance Companies & TPAs to provide cashless facility to its patients