List of major empanelled Insurance Companies (MEDICLAIM)(For CASHLESS facility)

• Medi Assist Insurance TPA Pvt Ltd
• Vidal Health Insurance TPA Services
• Star Health & Allied Insurance Company Ltd
• Family Health Plan Ltd (FHPL)
• Vipul Med Corp TPA Pvt Ltd
• Genins India TPA Ltd
• Raksha Health Insurance TPA Pvt Ltd
• Paramount Health Services TPA Pvt Ltd
• Medsave Health TPA Ltd
• E-Meditek Insurance TPA Ltd

PROCESS OF INSURANCE (CASHLESS CLAIMS) AT BRIDHAVVAN AREION HOSPITAL

Process for Cashless Claims:
A. Admission Process
B. Pre – authorization Process
C. Discharge Process

A.Admission Process:

• To check the availability for cashless facility by speaking to our staff.
• Policy holder shall produce copies of his/her ID card provided by TPA along with photo ID card for address proof (Driving License/Adhaar Card/Voters ID/Passport – any one) and Policy Certificate.
• The ID card should have photograph and signature or thumb impression of the patient.
• The beneficiaries (patient) will be identified by the provider (hospital) on the basis of a photo ID card issued by Insurance Company.

Insurance Help Desk staff will verify following details with the help of ID card & policy certificate copy;

• TPA Name
• Corporate name
• Patients name and spelling
• Card validity (From and To)
• Age verification
• Photograph verification
• Sum-Insured

The following Terms & Conditions shall be explained to the patient for availing cashless facility.

B. Pre-Authorization Process:
Procedure for cashless facility:
• When a doctor plans for admission, the in-house insurance staff will verify the ID Card , Photo ID, Policy Certificate copy and get the concerned pre-authorization form filled up and signed with the seal of the doctor. The Patient/attendant has to sign and enter the contact number in the pre-auth form. The same is sent to TPA / Insurance Company along with relevant investigations reports in case of planned admission. This can be done up to 7 days prior to expected date of admission.
• In case of emergency admission, duly filled-in pre-authorization form would be sent within 24 hours of admission. Any delay will be communicated with TPA by insurance staff.
• The Pre authorization approval issued by the insurance company will have the following details like amount guaranteed, sub limits for room category, surgical fees, eligibility of beneficiary, validity of the approval letter as per the benefit plan of the insured.
• The guarantee of payment is given only for the necessary treatment cost of the ailment covered and mentioned in the request for hospitalization.
• Any investigation or treatment carried out at the request of the patient apart from the authorization, such of those treatment charges will have to be borne by the patient only.
• When the cost of treatment exceeds the authorized limit an interim bill along with justification letter from treating doctor is sent for further enhancement of approval amount. At the time of discharge final approval should be obtained by sending the final bill, break up of charges, discharge summary, pharmacy bills and any other information as required by TPA.
• Patient discharge will be taken up on receipt of final approval.

C. Discharge Process:
• The final approval will have the eligible amount and remarks on exclusions like non-medical expenses, co-payment and other disallowances, the cost of which shall be borne by the patient. Hence, after collecting the difference of amount the patient would be discharged.
• If the enhancement amount does not get cleared by Insurance Company, the balance amount shall be paid by patient/attendant.
• If the total claim amount gets denied by Insurance Company (TPA), then the patient/attendant has to clear the bills generated as per the hospital’s norms.

Comments are closed.