A facility extended by Insurer to the beneficiaries, where the payment of the cost of treatment undergone by the by the beneficiary in accordance with the policy terms and conditions, are directly made to the hospital by the insurer or TPA up to the extent of preauthorization approved.
If Hospitalization is advised by the consultant, patient contacted with hospital insurance desk with TPA ID card.
Insurance desk will send the details to the respective TPA.
On receipt of preauthorization request TPA or Insurance Company will issue the authorization letter.
In planned Hospitalization patients get admitted on the date advice by a Doctor. You have to apply for the approval of estimated medical expenses to the TPA atleast 4 to 5 days before the date of hospitalization.
The request for authorization letter shall be send electronically along with all the relevant details within 24 hours.
The Guarantee of payment shall be given only for the medically necessary treatment cost of the ailment covered and mention in the request for hospitalization.
Non covered items have per terms and condition of the policy, like food provided to relatives - attendance, registration fee etc, must be collected directly from the insured.
The authorization letter by the insurer or its representatives TPA shall clearly indicate the amount agreed for providing cashless facility for hospitalization.
In the event of the cost increasing the provider may check the availability of further limit with the insurer representative to TPA.
In case the Insurer has opted for a higher accommodation then the one eligible under the policy the provider shall explain the effect of such option and also take a written consent from the patient at the time of admission.
In all such cases the insurance company shall pay for the expenses which are based on the eligibility limits of the Insured.
If hospitalization is not required the patients will be treated has OPD basis and the fees will be collected from the patient.
If the consultant advises hospitalization, patient must contact with hospital Insurance desk. Patients are identified on the basis of ID card issued by the Insurance/TPA.
Approach the Insurance desk
Nirmala Hospital will submit all the Original documents to the TPA's after the discharge of the patient. It will take a minimum 4 hours to get the reply from the Concerned TPA after sending the discharge summary and final bill. Insurer/ TPA will not pay what is not covered under the Insurance Policy. Therefore the patient has to pay the amount of such services (Non medical expenses).
Nirmala Hospital will submit all the Original documents to the TPA's after the discharge of the patient. It will take a minimum 4 hours to get the reply from the Concerned TPA after sending the discharge summary and final bill.
Insurer/ TPA will not pay what is not covered under the Insurance Policy. Therefore the patient has to pay the amount of such services (Non medical expenses).
So even if hospitalization is approved, these expenses need to be paid by the patient to the hospital while discharged.
