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Insurance

Please contact Insurance Help Desk, at The Reception, Family Hospital for all assistance regarding your Insurance claims.

 

List of our Insurance associates:

1.FAMILY HEALTH PLAN LTD
2. MEDI ASSIST
3. MD-INDIA
4. ICICI Lombard General INSURANCE
5. GOOD HEALTH PLAN LTD
6. STAR HEALTH INSURANCE
7. HERITAGE HEALTH INSURANCE
8. CHORAMANDAL GENERAL INSURANCE
9. E-MEDITEK (TPA) SERVICE LTD
10.Reliance General insurance
11.HDFC General insurance
 

Insurance claims and Hospitalization

FAQ – Frequently asked questions

 

What is cashless hospitalization?

Today, most health insurance policies offer cashless hospitalization facility and route your policy through a Third party Administrator (TPA). Network hospitals are those hospitals that your TPA has an agreement with. If you get admitted to a network hospital you will be eligible for cashless hospitalization, subject to the conditions mentioned in your policy. When you get the approval for cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially. This enables an insured customer to obtain admission and undergo the required treatment without direct payment. In case you are admitted to a non-network hospital, you will have to settle the bills directly to the hospital and then seek reimbursement through your TPA.

 

Can I just walk into a hospital and get admitted for treatment free of cost?

Approval and pre-authorization by your TPA is essential for cashless hospitalization. The hospital has no authority to approve or disapprove cashless hospitalization. The assigned TPA will mediate between the hospital and the insurance company and settle the bills on behalf of the insured customer.

 

Procedure to avail cashless hospitalization.
The estimated hospital expenses must be Pre-authorised by TPA.
Here is the procedure for Pre-authorisation.

 

1) In case of a planned admission:

a. Contact Insurance Help Desk at the hospital and present the original Health Insurance card issued by your TPA
b. Collect the pre-authorization forms pertaining to your TPA, fill up the details and get them duly signed by the Doctor.The treatment details have to be filled up by the Hospital.
c. After the forms are complete the Insurance help desk of the Hospital will fax them to the TPA and will revert to you on the approval/denial status.
d. It is advisable to apply at least 4-5 days prior to the date of hospitalization.

 

2) Emergency Hospitalization:

In case of emergency hospitalization, the Insurance Help Desk will take up your case on a fast track basis with your TPA and is likely to receive approvals within 24 hours during working days. For cashless treatment it is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can undergo the treatment by paying the necessary cash deposit. If you receive approval from your TPA, you are entitled for refund of the cash deposit.

 

What if the approval for cashless treatment is not given before the time of discharge?

In case you do not get your approval you will need to bear the entire expenditure incurred on the treatment. you will have to settle the bills directly to the hospital and then seek reimbursement through your TPA. Therefore it is always prudent to get approval before admission.

 
Cashless hospitalization may be denied

If the ailment for which hospitalization is being sought is not covered under your insurance policy for reasons like pre-existing ailment or specific exclusions or you have exhausted the eligible medical insurance cover for the year.

 

What if the actual medical expenses are more than the pre-approved amount?
You can approach the Insurance Help Desk to apply for an enhancement of the pre-approved amount. If the TPA turns down the request for enhancement you will need to pay the amount incurred in excess of your approved amount directly to the hospital before discharge.

 

Does cashless hospitalization cover all medical expenses?
Pre authorisation does not guarantee that all expenses will be reimbursed. Please note that the type of room and room rent will depend on the package approved by TPA. The expenses listed below are not reimbursable under cashless hospitalization. Registration / Admission fee, Telephone charges, Visitor / Attender charges, Ambulance charges, Charges for diet, Document charges, Toiletries, Non-medical expenses, Service charges, These charges are not covered. These need to be paid by you directly to the hospital at the time of discharge

 

In case of cashless hospitalization, what are the documents to be submitted at the time of discharge? All the original documents including bills, lab reports, discharge summary and claim form. All the original documents duly signed by you need to be submitted to the hospital.

 

Please contact Insurance Help Desk, at The Reception, Family Hospital for all assistance regarding your Insurance claims.