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 benefit without any inconvenience you need to go through the claim procedure.
Step 1: Patient presents for admission
Step 2: Filling up of the Pre Authorisation form by treating doctor and sending toTPA / 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 Details
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
1. Before admission please confirm with our admission desk/Medical insurance desk whether your insurance company/TPA is registered with us.
2. At the time of admission it is mandatory to provide the following documents issued by your insurance company/TPA at our admission desk
→ Valid TPA/Insurance card
→ Proof of identity
→ Policy documents
3. When can you be asked to pay even if you have a cashless insurance policy:
→ 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 discharge 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 wherein 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 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. As per the system adopted by most health insurance companies /TPA’s the final sanction is sent 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. 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.
8. 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)
