Insurance & TPA Information

Critical guidelines for TPA and Cashless admissions, including pre-authorisation, emergencies, billing, and reimbursement rules.

Our hospital has some of the leading corporates and TPA or insurance companies to help our patients with cashless and hassle-free hospitalization. With our long-term association with the companies, we ensure to deliver the best services to our patients.

Policy details

Clear guidance on authorisation, billing, and reimbursement.

Understand the insurance process before admission, during treatment, and at discharge.

Policy section

Admission Basics & Authorization

Patients are admitted under cashless based on an I-Card from tied-up insurance or TPA companies.

Emergency admissions begin based on E-card or policy paper, but getting the final authorization letter to the hospital remains the patient's responsibility.

Planned admissions will be entertained based on an INTIAL AUTHORISATION LETTER, which must be verified by the TPA desk prior to admission.

Getting the authorization is the primary responsibility of the patient. The hospital only facilitates document processing.

All TPA patients are considered regular patients and must pay necessary charges until initial authorization is received. Paid amounts are adjusted or refunded at discharge.

SMS approval on mobile is not considered as authorization. It depends solely on the authorization letter sent via email or uploaded on the portal.

Actual facts are furnished to the TPA in the pre-auth form. Alteration requests not matching the treatment will not be entertained.

Policy section

Discharge, Delays & Billing Rules

On discharge day, if final authorization does not arrive within 4 hours of sending documents, the patient must pay the bill in full and claim reimbursement.

If final approval is not received, or if the TPA rejects/delays the authorization letter within 2-3 days of admission, the patient must bear the bills and go for reimbursement.

Costs due to change in treatment, additional treatments, or crossing the sanctioned limit must be settled by the patient from time to time.

For GIPSA patients, any charges above the package due to increased stay or treatment changes must be borne by the patient.

Policy section

Exceptional Scenarios

Certain outside investigations (like MRI or pathological tests) must be paid by the patient first, and will be adjusted/refunded once the hospital receives payment.

If a patient takes Discharge Against Medical Advice (LAMA), cashless service is void and the bill must be settled in full.

If a patient transfers to another hospital, the bill must be settled in full (no adjustments or refunds will be processed by the hospital).

In case of communication failure (internet/telephone), the hospital is not responsible. Patients must pay in full and seek reimbursement.

In case of a TPA patient's death on a Sunday or Holiday, cashless processing happens on the next working day. Relatives must settle the bill in full and go for reimbursement.