Guidelines
for Cashless Hospitalization
Whether all Medical Insurance cover the cashless facility
Most of the health insurance company offer cashless hospitalization
through a third party administrator. With the terms of network
and non-network hospital.
Network hospital means that TPA has an agreement in case of hospitalization,
if you get admitted to a network hospital you are eligible for
cashless facility, subject to other terms in you policy ,in case
if you admitted to a non network you are eligible for reimbursement
not for cashless.
Cashless facility means the treatment
is free of cost
You need to understand that the treatment is never be free of
cost, cashless means insurance will pay for the treatment either
fully or Partially.
Most of the health insurance will mediate between the healthcare
provider (hospital) and insurance company and settle the bill
on behalf of the insurer.
Hospital play has as an facilitator and does not have any authority
for approvals or disapprovals, to obtain Cashless we need to follow
strictly the protocols of IRDA and adhered to it.
Types of hospitalization to get cashless
facility
Two types of hospitalization – planned
and emergency.
Planned hospitalization
It means consultant will advice the date of admission in such
cases you must apply preapproval from hospital directly with your
TPA before 3-4 days before hospitalization.
If treating doctor advice for hospitalization immediately our
Corporate help desk will help for pre authorization request.
Emergency Hospitalization
Any case of emergency help desk will take up on fast track with
your respective TPA and you will receive an approval with in 3
hours during any Working days.
For cashless it is must that the hospital should receive approval
from TPA. In case of delay or when you cannot able to wait owing
medical urgency you can undertake the treatment by paying the
necessary cash deposit. If you receive approval from TPA , hospital
will refund the cash deposit.
Preauthorization details to get cashless
1) Policy Number with corporate and personnel details.
2) Pertaining to your treatment treating doctor need to fill up
with duly signed.
3) Once the preauth form is filled up completely the corporate
help desk will fax or sent by online to your respective TPA.
4) Help desk will get back to you on the approval or any discrepancy.
Reason for denial of cashless facility
1) If insufficient information given to TPA and various reasons
under this criteria there is a chance of rejection.
2) The ailment for which Hospitalization is not covered under
your insurance policy like pre existing ailment, specific exclusion
(like influence of alcohol)
3) Medical insurance coverage is exhausted then there will be
a denial of insurance.
If a Medical Expense shoots up the
approval amount
Your hospitalization expenses exceed the approval amount
you can approach the help desk to apply for an enhancement of
the amount.
Apply an enhancement to provide the necessary documentation if
you have not exhausted the limit of insurance your TPA will approve
the application for enhancement.
If your TPA denies then you will need to pay the amount incurred
in excess of your approved amount directly to hospital before
the discharge.
Cashless cover for all medical expenses.
You need to go through your health insurance policy
to know the coverage of your complete medical expenses. In general
expenses below are not payable.
Registration/ admission fee
Telephone charges
At tenders/visitors charge
Ambulance charges
Document charges
Non medical expenses
Service charges
Need to be settled at the time of
discharge
Documents required for hospital to provide cashless
facility
All the original documents including bills, lab reports, pharmacy
breakup, scan reports, x-ray, MLC copy of discharge summary, signed
claim document, ID proof of the patients.
TPA with whom GREENVIEW has tie up
GREENVIEW has a tie up with major TPA and preferred
network partner for IT Major. Contact the help desk for updated
list.
TTK HEALTHCARE PVT LTD
MEDIASSIST INDIA PVT LTD
BAJAJ ALLIANZ GENERAL INSURANCE CO LTD
PARAMOUNT HEALTHCARE SERVICE PVT LTD
MEDICARE TPA SERVICES
UNITED HEALTHCARE PVT LTD
RAKSHA TPA
MD INDIA HEALTHCARE PVT LTD
ACCIDENT RELIEF CARE PVT LTD
E-MEDITEK PVT LTD
SWASTIK PVT LTD
CHOLAMANDALAM MS GENERAL INSURANCE
VIPUL MED CORP PVT LTD
ICICI LOMBARD GENERAL INSURANCE COMPANY LTD
FAMILY HEALTHPLAN LIMITED
MEDSAVE HEALTHCARE LTD
GENINS INDIA LTD
DEDICATED HEALTHCARE SERVICES INDIA PVT LTD
STAR HEALTH AND ALLIED INSURANCE COMPANY LTD
GOOD HEALTH PLAN LTD |
