Hospitalization occur under two conditions: Planned & Emergency.
If doctor advised you on the probable date of hospitalization in such case, you must have applied for an approval of the estimated hospital expenses directly with your TPA at least 4-5 days prior to the date of hospitalization
For cashless treatment it is mandatory for the hospital to have an approval from TPA or Credit letter from Corporate. In case of emergency hospitalization, you can undertake the treatment by paying the necessary advance cash deposit. If you get approval from your TPA / Corporate after paying cash deposit, you are entitled for refund at the time of discharge.
Pre- Authorization of the estimated hospital expenses is a must to avail cashless facility.
The pre-authorization procedure is detailed below:
Step 1 : Established contact with the corporate / TPA help desk at the hospital.
Step 2 : Collect the Pre-Authorization of your respective TPA.
Step 3 : Your Pre-Authorization will have two sections –
Step 4 : Return the completed form to the Corporate / TPA help desk with respective TPA ID card, relevant prescriptions & reports. The Corporate clients submit original copy of your Credit letter with ID & Address proof.
Step 5 : Once the form & related formality is complete in all respect, the Corporate / TPA help desk will fax the form to TPA office & after receiving the approval the help desk will revert on the approval status.
4. What will I do if approval from TPA not received till the time of discharge?
Cashless hospitalization is linked to the approval of the estimated expenditure on proposed treatment. In case you not received approval you need to pay the entire bill incurred on the treatment.