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CASHLESS CLAIM PROCESS

How to avail cashless facility in Network Hospital / Nursing

1.1 Obtain the Medical details of your ailment from treating doctor For all hospitalization, insured has to give prior intimation (before admission) in the prescribed format to TPA helpdesk.

In case of any elective (PLANNED) hospitalization, intimation should be preferably 3-4 days before hospitalization. For an EMERGENCY Hospitalization, intimation to be sent within 24 Hrs. Of admission

1.2 Call up and Fax CALL and FAX a request form for cashless admission in the network hospital to TPA and enable TPA to verify your coverage eligibility as per the policy terms and conditions.

A regular follow up with the TPA desk at the hospital is a must "do" for additional information as may be required by the TPA on a case to case basis

1.3 Get the Pre Authorization TPA will issue an Authorization Letter (AL) post verification of your documents as per policy terms and conditions

1.4Avail of the Cashless Hospitalization (where prior approval taken) If approval is taken prior to hospitalization, Insured are requested to approach the Admission / Reception Counter of the hospital on the day of admission with the Authorization Letter and your Medi Card.

For additional amount, kindly arrange to fax the request with the final bill and discharge summary or other documents if asked by the TPA before getting discharged from the Hospital.

At the time of Discharge, kindly insist for & and retain with you a copy of TPA approval

2.The denial of cashless facility does not mean denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization.

Post discharge, beneficiary can submit the claim documents to the TPA for reimbursement subject to admissibility of the claim as per terms and conditions of the policy not later than 30 days from date of discharge.

3. Submission of claim documents

The Insured should submit all the following documents and reports in original within given submission period retaining photocopies of all such documents for your own record

i.e. within 30 days from the date of discharge for main claim and for post hospitalization, within 30 days from date of completion of post hospitalization treatment.
  • Duly Signed Claim Form in Original
  • Mention TPA Medi card number and TPA claim intimation number(must)
  • Enclose intimation mail copy in case of unavailability of intimation no.
  • Original Hospital Bill / detailed breakup of the final bill / Payment Receipt
  • Original Discharge Summary / Card
  • All original investigation reports / X-rays films / Scans, ECG etc.
  • Original Bills and receipts for investigations along with Doctors prescriptions
  • Original Bill of Pharmacy, Laboratories along with corresponding original prescription duly endorsed by the treating doctor
  • In case of Surgeons/ Consultants bill, kindly insist on a stamped, preferably Numbered receipt
  • Hospital Registration Number
  • Your telephone No / Mobile No / Email I.D. for future correspondence.


4. Submission of Deficient documents

Query reply to be submitted at TPA desk within 45 days from the 1st Query letter
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