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LIST OF T.P.A.
UNITED HEALTH CARE
I - HEALTHCARE
DEDICATED HEALTHCARE SERVICES
HOSPITALISATION BENEFIT FOR TPA PATIENTS
Patients can utilize the benefit of cashless hospitalization at our hospital if the concerned TPA is enrolled with us.
WHERE TO GET PRE- AUTHORISATION FORMS :
The forms can be collected either from the enquiry counter/TPA department. The concerned staff will explain how to fill the details.
PROCESS FOR ADMISSION
For planned admissions, cashless approval should be obtained from the TPA at least two days prior to the date of admission.
Emergency admission, the cashless forms should be filled within 2 hours of admission.
TPA department will help in faxing the duly filled preauthorization form of the TPA along with the latest policy copy, positive investigation reports, first consultation paper and I.D. Proof.
If additional requirement is asked by the TPA. It has to be provided by the patient.
At the time of admission, even if the TPA has approved cashless, a refundable security deposit of Rs. 20,000/- has to be paid by the patient.
During Hospitalization :
The patient must give a proper and true medical history to the doctor at the time of filling in the pre-authorization form, since any discrepancy may result in the denial of the claim and cancellation of the approval.
Receiving an authorization letter for cashless benefit is only tentative. If the claim is denied for any reason by the insurance company during the course of treatment or after patient is discharged, 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
If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the department to the TPA. However, it is primarily the responsibility of the patient/relative to keep track of the bill. If no enhancement is received from the TPA, the patient will have to pay for the bill amount over and above the sanctioned amount by the TPA.
To get the cashless approval the patient has to keep a follow up with the respective TPA.
Discharge process :
The hospital will retain Rs. 35,000/- refundable deposit for every one lakh of the sanctioned amount as deposit until the hospital received complete payment from the TPA. On settlement of payment from the TPA, the patient will be intimated by SMS regarding procedure of refund of deposit.
The hospital collects payment for all exclusions/non-medical expenses/surcharge, if they are not covered by TPA at the time of discharge.
No original hospital documents or reports are given to the patient, since these are sent by the hospital to TPA along with the bill for reimbursement. Xerox copies of the same can be taken by the relative.
At the time of discharge, the patient can collect a copy of detailed bill/summary from the accounts department.
Denial process :
On denial of cashless hospitalization by the TPA, the patient will be treated as a cash paying patient and will have to make the necessary payments as per hospital policy.
For Reimbursement :
For patients who do not avail the benefit of cashless hospitalization o0r whose claims are denied for cashless, can contact their respective TPA along with patient's discharge card, original reports, claim form of insurance company and hospital bills. The hospital bills are to be attested by Sr. Medical Superintendent/Officer on special duty for reimbursement. If the indoor case papers are required, the patient/relative have to make an application in the Medical Superintendent;s Offic during working hours.
LIST OF CORPORATES
BANK OF BARODA
RESERVE BANK OF INDIA
UNION BANK OF INDIA
ANGLO EASTERN SHIP MANAGEMENT (INDIA) PVT. LTD
MAHINDRA & MAHINDRA
LARSEN & TOUBRO LTD
PALANPUR SAMAJ TRUST
THE SHIPPING CORPORATION OF INDIA
BHARAT PETROLEUM CORP. LTD
HINDUSTAN PETROLEUM CORP. LTD
MUMBAI PORT TRUST
FOUR SEASONS HOTEL
CORPORATE PATIENTS :
As per the list of corporate clients, their patients are admitted without any deposit.
At the time of admission corporate patient has to provide company I.D., or Letter of Corporate.
Admission will be subject to availability of beds. Hospital reserves the right to admit the patient to any other class, if accommodation is not available in the desired class. Hospital will be the sole judge of availability of beds and into which class the patient should be admitted if the desired class is not available. The decision of hospital will be binding on the corporate.
The charges which are not covered by the corporate has to be paid by the patient at the time of discharge