Insurance & TPA Information

Clear guidance for cashless admission, pre-authorisation, emergency insurance processing, security deposits, and reimbursement fallback.

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

Cashless admission basics

Cashless admission is available only for insurers or TPAs tied up with the hospital and is subject to authorisation.

Patients can be admitted under cashless based on an insurance or TPA card, e-card, or policy paper from a tied-up insurer or TPA.
Emergency admissions may begin based on e-card or policy papers, but it remains the responsibility of the patient or relative to get the authorisation letter to the hospital.
All TPA patients are considered regular patients until initial authorisation is received and must pay necessary charges first.
Amounts paid during admission are adjusted or refunded at discharge, subject to verification of final approval.

Policy section

Planned admissions and prior approval

All planned admissions are entertained only on the basis of an initial authorisation letter.
The Department of Corporate Relations or TPA desk verifies the initial authorisation before admission.
For planned surgery or admission, the patient is responsible for obtaining prior approval from the TPA or insurance company.
The approval documents must be produced at the admission counter and wherever else required.

Policy section

Discharge, delay, and reimbursement rules

On discharge day, the discharge card and final bill must be sent to the concerned TPA or insurance company for final authorisation.
Patients may need to wait until final authorisation is received from the insurer or TPA.
If final authorisation does not reach the hospital within 4 hours after mail or portal submission, the patient must pay the hospital bill in full and claim reimbursement.
If TPA rejects or delays authorisation within 2-3 days of admission, the patient must bear hospital bills and may put the file for reimbursement.
If final approval is not received from the TPA or insurance company, the patient must pay the final bill and go for reimbursement.

Policy section

Sunday, holiday, and system-failure situations

There is no cashless processing on Sundays, public holidays, or hospital holidays.
If telephone lines, internet, or other communication systems fail at the hospital or TPA end, the hospital is not responsible for resulting delays.
In such cases, patients may need to make full payment and proceed through reimbursement.
In a death case under TPA or insurance on Sunday, public holiday, or hospital holiday, cashless processing happens only on the next working day and relatives may need to settle the bill first.

Policy section

Security deposit, deductions, and package differences

A minimum non-interest-bearing security deposit of 15% of the final approved amount is collected at discharge from TPA patients.
If the patient stay increases beyond 21 days, the security deposit is 20%.
The deposit is collected toward non-medical and other expenses not borne by TPA or insurance companies and is adjusted after the hospital receives payment.
TPA or insurance companies may deduct administrative charges, admission charges, pharmacy charges, and other non-medical items, which must be paid by the patient.
For GIPSA patients, if duration of stay increases or treatment changes beyond package, charges above package must be borne by the patient or relative.

Policy section

Outside investigations and special billing situations

Actual facts are furnished to the TPA in the pre-authorisation form, and alteration requests that do not match treatment or ailment are not entertained.
Certain investigations such as MRI and some pathology tests may be done outside the hospital. The patient may need to bear the cost first, with adjustment or refund after company payment is received.
If the patient takes discharge against medical advice (LAMA), cashless service is not applicable and the bill must be settled in full.
If a patient transfers to another hospital, the bill must be settled in full. Adjustment is possible only if approval is received within 4 hours after final bill and discharge documents are sent.
Costs due to change in treatment, additional treatment, or bill amount crossing the sanctioned limit may not be paid by the TPA and must be settled by the patient from time to time.