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Cashless Claim

  • The TPA will issue you an IDENTITY CARD which will indicate the name of your TPA.
  • Your insurance agent/or COMPANY HR PERSON will be able to inform you accurately.
 

The pre-authorization forms of TPA tied up with the hospital can be collected from the BILLING department once done with admission procedure at RECEIPTION department.

 

Patients can avail of the benefit of Cashless hospitalization at ICON Hospital if the TPA that the patient is covered by is tied up with the hospital.

 

Possessing a TPA identity card does not automatically entitle the patient to get Cashless benefit. A certain defined procedure for obtaining sanction from the TPA has to be followed.

 
  • For all elective / planned admissions/planned surgeries/day care procedures, Cashless approval should be obtained from the TPA atleast 3-days prior to the date of admission.
  • BILLING DEPARTMENT & SURGERY CO-ORDINATOR will assist you to communicate respective TPA along with the duly filled pre authorization form of the TPA & necessary clinical details(along with the latest policy copy and positive investigation reports.)
  • At the time of admission, even if the TPA has approved cashless, a refundable security deposit of 10% of approval amount in case of billing over 1 lakh as per Hospital policy is to be paid by the patient at BILLING department.
  • Incase the bed class / room specified in the authorization letter is not available, the patient will be admitted in the higher or lower class as per choice of patient. In case of admission in the higher class, patient will have to pay the praportionate difference in the charges from the date of admission.
 
  • The patient must give a proper and true medical history to the doctor at the time of filling in the pre authorization form, since any discrepancy may result in the denial of the claim and cancellation of the approval.
  • In case the patient is transferred to ICU/HDU/ DAY CARE ROOM and wants to retain the original bed then patient will have to keep an additional security deposit, depending on the class and number of days in ICU/HDU/ DAY CARE ROOM, as the TPA does not pay for dual occupancy.
  • Receiving an authorization letter for Cashless benefit is only tentative. If the claim is denied for any reason by the insurance company during the course of treatment or after patient is discharged, patient will be responsible for payment of the hospital bills, as per the undertaking which the hospital collects at the time of registration under respective TPA.
  • If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the billing department to the TPA. However, it is primarily the responsibility of the patient / relative to keep track of the bill. If no enhancement is received from the TPA, the patient will have to pay for the bill amount over and above the sanctioned amount by the TPA.
 
  • The hospital will retain (10% of sum insured as per policy)refundable deposit of the sanctioned amount as deposit until the hospital receives complete payment from the TPA. On settlement of payment from the TPA, the patient will be intimated by TELEPHONE CALL for procedure of refund of deposit from ACCOUNT DEPARTMENT.
  • The hospital shall collect payment for all exclusions / non-medical expenses / surcharge, if they are not covered by TPA at the time of discharge.
  • No original hospital documents or reports will be given to patient, since these are sent by the hospital to TPA along with the bill for reimbursement. Photo copies of the same can be taken by the relative.
  • At the time of Discharge, the patient can collect a copy of detailed bill / summary from the BILLING department.
  • Any pending reports or films should be collected from the RADIOLOGY department within 10 days of discharge.
 

On denial of Cashless hospitalization by the TPA, the patient will be treated as a cash paying patient and will have to make the necessary payments as per hospital policy OF CASH RATE OF HOSPITALISATION.

 
  • For patients who do not avail the benefit of Cashless hospitalization or whose claims are denied for Cashless, please contact your respective TPA along with patient’s Discharge card, all Original reports, claim form of insurance company and hospital bills (to be attested by MEDICAL Officer on Special Duty) for reimbursement. If the Indoor case papers are required, kindly make an application in the RECEIPTION addressing COO during working hours.
  • BILLING department will assist you and guide you in the process of obtaining the cashless facility from the TPA / Insurance company. However the primary responsibility of obtaining the authorisation would be of the patient / relative.