Procedures for Cashless Hospitalization
Health Insurance Patient Insurance Information database
Patients with medical insurance who undergo day care procedures like phaco emulsification cataract or any eye surgery requiring hospitalization are registered for health insurance details. The details should include name, age, ID number, policy number, and nature of the illness, diagnosis, treatment to be given and the estimated cost of the procedure or treatment with patient’s declaration of medical insurance of the respective insurance company.
The clinical information of the patients along with their medical policy details are to be forwarded to the third party administrator either by fax or email, for the prior approval of patient’s treatment in our hospital. Necessary documents for the same are to be brought by the patient
After the pre – authorization request has been sent by the hospital to the TPA. For planned surgery or treatment the TPA must be approached 7 days in advance and the hospital treats patients only after the approval has arrived from TPA. In the case of emergency, the patients are admitted and the same will be informed to the TPA at the earliest. Our medical team interacts and co ordinates with the TPA for further clarification and explanation. After the approval from the TPA the patient will be informed about the same accordingly.
Cashless hospitalization and treatment are provided to the patients only with the approval of the company. Patients should sign the necessary documents to facilitate claim processing for the hospital. Patients who don’t get approval due to some reasons stated by the insurance company are also treated under the general patient’s category without cashless hospitalization benefits and can claim benefits by reimbursement.
(Please note that the charges for Pre/Post-operative investigations, the pre-operative and post-operative medications are not included in the pre-authorization. Lasers, some injection procedures and ophthalmic investigations such as FFA, OCT, B-scan, A-scan, Perimetry etc are also not sanctioned by TPA)