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ISO Certified Hospital
 
MADICLAIM CASHLESS ADMISSION
 

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.

 
ADMISSION PROCEDURE:


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.

 
 
WHAT TO DO AFTER DISCHARGE FROM HOSPITAL?

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.

 
REIMBURSEMENT OF EXPENSES INCURRED FOR TREATMENT AT NON NETWORK HOSPITAL

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. .

 

CASHLESS SERVICES
ALANKIT HEALTH CARE
BAJAJ ALLIANZ
DAWNS SERVICES
EAST WEST ASSIST
E-MEDITEK ASSIST
FAMILY HEALTH PLAN
PHA
HEALTH INDIA
MED SAVE HEALTH
MEDI ASSIST
MEDICARE
PARK MEDICLAIM
GEMINS INDIA
PARAMOUNT
RAKSHA
TTK HEALTH CARE
VIPUL MEDCORP
Z MEDICARE
INTERNATIONAL SOS
HERITAGE HEALTH
DEDICATED HEALTH SERVICES
SHRIRAM LIFE


PRE-INSURANCE HEALTH CHECK UP
UNITED INDIA INSURANCE
UNITED HEALTH CARE
AVIVA
MET LIFE
ICICI PRUDENTIAL
MAX NEW YORK
ORIENTAL INSURANCE
HDFC
DEHAT
SBI LIFE
TATA AIG
NEW INDIA ASSURANCE
BAJAJ ALLIANZ
EMC
RELIANCE
ING VYSYA
PRESTIGE HEALTH


ON PANEL
RBI
ONGC
BANK OF BARODA
UNION BANK OF INDIA
NABARD


WHEN CASHLESS ACCESS TO HOSPITAL CAN BE DENIED

  • IN CASE SUFFICIENT DATA IN THE PRESCRIBED FORMAT IS NOT GIVEN.
  • IN CASE OF VAGUE SYMPTOMS WHEN MEDICAL TEAM OF TPA IS NOT SURE OF OLIGIBILITY UNDER THE COVERAGE DUE TO INADEQUATE MEDICAL INFORMATION, PRE-AUTHORIZATION FOR CASHLESS CAN BE DENIED.
  • ABOUT 95 % OF ADMISSION IN THE HOSPITAL ARE PLANNED. THEREFORE IT IS NECESSARY FOR YOU TO OBTAIN YOUR AUTHORITY LETTER IN ADVANCE.
  • SOME INSURANCE POLICIES DO NOT COVER PRE-EXISTIONG DISEASES & COMPLICATIONS OF CHRONIC CONDITIONS. YOU ARE ADVISED TO GIVE ALL REQUIRED INFORMATION TO THE MEDICAL TEAM OF TPA SO THAT VERIFICATION OF ELIGIBILITY IS POSSIBLE.

THE DENIAL OF AUTHORISATION FOR CASHLESS ACCESS DOES NOT IN ANY WAY PREVENT YOU FROM SEEKING NECESSARY MEDICAL ATTENTION OR HOSPITALIZATION. IN SUCH CASES YOU ARE ADVISED TO FILE YOUR CLAIM FOR REIMBURSEMENT AND TPA WILL SETTLE THE CLAIM AS PER ELIGIBILITY AND POLICY COVERAGE.