INFORMATION ABOUT TPA NETWORK OF SERVICE PROVIDERS

• THE CASHLESS ACCESS IN TPA NETWORK OF HOSPITALS IS MERELY A FACILITY EXTENDED TO YOU BY THE TPA UNDER CONTRACT WITH YOUR INSURER.

HOW TO GET ADMITTED IN A NETWORK HOSPITAL / NURSING HOME?

PRE-AUTHORIZATION IS ABSOLUTELY NECESSARY WITHOUT WHICH THE NETWORK PROVIDER WILL REFUSE CASHLESS SERVICES. PLEASE SEND THE HOSPITAL ADMISSION REQUEST NOTE FROM THE ATTENDING PHYSICIAN STATING THE FOLLOWING TO TPA VIA FAX / COURIER / E-MAIL / MESSENGER.

• ALIMENT AND ITS DURATION.
• KNOWN PAST ILLNESS IF ANY.
• HYPERTENSION OR DIABETES.
• THE NAME OF THE HOSPITAL / NURSING HOME AND CONSULTANT. (CONTACT NO. OF CONSULTANT ).
• THE PROPOSED DATE OF ADMISSION.
• CLASS OF ACCOMMODATION.
• THE APPROXIMATE DURATION OF STAY.
• THE APPROXIMATE EXPENSES.
• TREATMENT PLAN.

AFTER DUE SCRUTINY, TPA WILL SEND AN AUTHORIZATION LETTER (AL) FOR CASHLESS TREATMENT AND GUARANTEE OF PAYMENT. THIS IS SUBJECT TO THE TERMS, CONDITIONS, EXCLUSIONS AND LIMITATIONS OF YOUR HEALTH COVERAGE PLAN.

IN ORDER TO SECURE ADMISSION ON THE APPOINTED DAY, YOU ARE ADVISED TO REGISTER YOUR NAME WITH THE HOSPITAL WELL IN ADVANCE. APPROACH THE ADMISSION / RECEPTION COUNTER OF THE HOSPITAL ON THE DAY OF ADMISSION WITH THE AUTHORITY LETTER AND YOUR ID CARD. (TPA WILL ALSO ARRANGE TO SEND AUTHORITY LETTER TO THE HOSPITAL.) THE HOSPITAL / NURSING HOME WILL ADMIT YOU AND EXTEND THE CREDIT FACILITY UPTO THE AMOUNT GUARANTEED BY TPA SUBJECT TO AVAILABILITY OF BED.CHARGES FOR THE CERTAIN FACILITIES ARE NOT COVERED BY MAJORITY OF HEALTH PLAN, FEW OF THEM ARE AS UNDER:

• THELEPHONE / FAX.
• FOOD & BEVERAGE FOR RELATIVES.
• BARBER.
• AMBULANCE (UNLESS THE POLICY SPECIFICALLY COVERS IT).
• EXTERNAL IMPLANTS AND ACCESSORIES SUCH AS CRUTCHES, SPECTACLES, ETC. UNLESS SPECIFICALLY COVERED.
• ETC. ( AS PER TPA POLICY)

COST OF SUCH SERVICES MAY HAVE TO BE BORNE BY YOU AND PAID DIRECTLY TO THE HOSPITAL. IN CASE HOSPITAL INADVERTENTLY BILLS PHM FOR SUCH SERVICES, THESE AMOUNTS WILL BE RECOVERED FROM YOU.

REIMBURSEMENT OF POST HOSPITALIZATION EXPENSES MEDICAL EXPENSES INCURRED AFTER DISCHARGE FROM THE HOSPITAL WILL BE REIMBRUSED AS PER YOUR HEALTH COVERAGE PLAN. PRESCRIPTION AND BILLS / RECEIPTS OF SUCH SERVICES SHOULD BE SUBMITTED TO TPA ALONG WITH THE CLAIM FORM DUTY SIGNED BY YOU.

INTIMATION TO TPA IS A MUST EVEN IN A NON-NETWORK HOSPITAL. IN CASE YOU CHOOSE TO GET TREATED IN A NON-NETWORK HOSPITAL, YOU WILL HAVE TO PAY THE COST OF YOUR TREATMENT. HOWEVER, YOU HAVE TO SUBMIT THE FOLLOWING DOCUMENTS IN ORIGINAL TO TPA TO OBTAIN REIMBURSEMENT OF ELIGIBLE CLAIM AMOUNT.

• HOSPITAL BILL AND RECEIPT FOR PAYMENT.
• INSURANCE CLAIM FORM DULY SIGNED BY YOU.
• DISCHARGE CARD / SUMMARY.
• PRESCRIPTIONS AND BILLS OF DRUGS IF PURCHASED BY YOU.

ALL RECEIPTS OF PAYMENTS OVER RS. 500/- SHOULS BE DULY STAMPED WITH A REVENUE STAMP. IN CASE OF SURGEONS / CONSULTANTS BILLS, KINDLY INSIST ON A STAMPED, PREFERABLY NUMBERED RECEIPT. .