If you have been rushed to the Institute in an emergency situation, and have been routed to the Emergency wing, all necessary care will commence immediately after the doctor on duty has assessed your medical condition, without waiting for approval by your insurance agency.
You are required to submit a photo identity proof, valid TPA / insurance membership card, and a proof of employment with your organization (in case you are covered under a corporate / organization sponsored Insurance), at the TPA / Admission Desk within 20 hours of your arrival in the Emergency, so that our team can send your application for approval, to the TPA / insurance agency.
Irrespective of the amount approved, all health insurance policies specify the items which are not included in the approved amount, and have to be paid for by the patient, depending upon their particular policy’s terms & conditions. Items such as monitoring charges, infusion pump, specific drugs, disposables, certain tests, etc., are usually not paid for by the TPA / insurance agency, as per IRDA guidelines. A list of these items is included on the last page of this communication; these items must be paid for by the patient, at the time of discharge.
In case the TPA / insurance agency rejects the pre-authorization, you will be admitted as a cash paying patient. Once your treatment is over and you are discharged from the Institute, you can file a claim of reimbursement with your TPA / insurance agency.
A planned admission is one where the patient, in consultation with his / her treating doctor, decides the date of getting admitted for treatment.
If you have been advised by your doctor, or are planning, to get admitted for treatment, please report to the TPA Desk at least one day in advance. Our team will help fill your pre-authorization form and send it to your TPA / insurance agency, along with a financial estimate of the treatment, to apply for approval of admission.
Prior approval of your admission and treatment by your TPA / insurance agency is mandatory in case of planned admissions, according to IRDA guidelines.
Once an approval for admission is received, the TPA Desk will inform you and the Admissions Desk, so that you can be admitted as a cashless patient, i.e. you do not need to pay the hospital for your treatment till the limit approved by the TPA / insurance agency.
At the time of Discharge, the Discharge Summary (which explains your medical condition at admission and the treatment given to you during hospitalization) along with your final bill, is sent to the TPA / insurance agency by our TPA Desk, for approval of the final billed amount. On an average, a TPA / insurance agency takes 3-4 hours to revert with their approval / denial.
Once an approval is received, the TPA Desk will inform you and you can settle the bill at the Cash Counter as per the amount approved and your share in the payment. All prescriptions, reports, bills and films will be retained by the Institute to file a claim of the billed amount, with the TPA/ insurance agency.
If the TPA / insurance agency sends a denial or rejection of your final bill and treatment (based on their guidelines), you will be required to pay the complete billed amount. You can file a claim of reimbursement with your TPA / insurance agency, after settling your bills at discharge.
All documents including your Discharge Summary, prescriptions, test reports, films, ECG strips and pharmacy bills will be handed to you so that you can complete the claim filing requirements. Most health insurance companies have now made it very easy to file reimbursement claims, please contact Your TPA / insurance agency for guidelines on the same.