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INSURANCE SERVICES

 
Cashless Hospitalization
Facilities of Cashless Available
  • M.D. India
  • Paramount
  • Vipul TPA
  • Medicare TPA
  • Medi Assist
  • Cholamandalam
 
Q : If I have I-card of the insurance company, does it make me eligible for cashless services?
NO. To avail a cashless facility just having I-card will not work. You will need to have the policy also. Suppose the employee is, a patient of a corporate which has group mediclaim then that employee has to carry his company ID card also. Under certain circumstances, it is quite possible that one may not avail of cashless facility
Q : Which documents are needed to avail cashless facility?    
  • Previous two 2 years policy
  • ID card copy
  • If premium is paid by Cheque then copy of 64 VB certificate
  • In case of accident case patient has to give self-declaration
  • In case of police case copy of FIR.
  • All previous check up, blood investigation & X-ray, USG, MRI reports
Q : Whose responsibility is it to get cashless permission from the TPA?
To get AUTHORISATION (permission) from the TPA is the responsibility of policyholder. But at Baroda Hospital this responsibility is shouldered by insurance department of hospital. Insurance executives of Baroda Hospital forward all required documents to the TPA. The department then follows this up with TPA through phone calls, faxes and even personal visits to the TPA office if required. Once the authorization is received from the TPA, the patient is informed.
Q : Under which circumstances patient cannot avail cashless facility?
  • If the patient has not completed one year of insurance policy (except in case of accident).
  • If the premium has not been paid regularly.
  • If the patient is having the disease from birth or it is preexisting while taking the policy.
  • Admissions for getting investigation charges reimbursement are not approved by insurance sector
Q : Is cashless facility available in every hospital?
NO. The insurance co. and the TPA consider the policyholder as their close family members and hence only after extensive survey, they empanel the hospitals. Such hospitals has needful infrastructure & they meet strict standards of quality. Baroda Hospital is on the panel of all TPA’s since last five years & offer the highest quality of healthcare.
Q : Is cashless facility available for OPD consultation?
NO, cashless facility is not available for OPD consultation.
Q : Do cashless services claims sometimes take more time than what is stipulated?
YES. If TPA Company needs more information about patient’s treatment or needs some specific reports. Then this takes more time than normal. But this does not happen every time & in most of the cases approval comes in a day or two.
Q : After getting a cashless authorization with in how many days treatment should Start?
When TPA issue the Authorization Letter they already mention the admission date of patient (date which is fixed by the patient & the hospital authority & it is the same, mentioned in the admission request note). Usually Patient has to get admitted on that day only, but if for some reason patient can not get admitted to the hospital; then in that case the hospital gets an extension of that date from TPA.
Q : When TPA issues cashless Authorization does it put any restriction?
Certainly, the restriction could be as under,
  • Reduction in the amount asked ( depends on policy terms)
  • Non allotment of special/ac/suit room
  • Stay for necessary days only
  • Ambulance charges are not reimburse
  • Personal expenses of patient
  • If permission has been received for some particular treatment then claim can not be provide for other disease
  • TPA puts this restriction as per the policy of the policy holders.
Q : If I have a cashless mediclaim policy don’t I have to pay for anything?
The Authorization letter is issued only for the period between admission & discharge. So the pre hospitalization & post hospitalization expenses has to be borne by the patient.
Q : In case the actual expense exceeds the authorization amount what can/should I do?
This happen many a time, if the expenses exceed than the authorized amount, patient has to pay the difference to the hospital & then reimburse /claim the amount from the TPA.
Q : If I have spent money before availing cashless facility, what should I do?
The Authorization letter is issued only for the period between admission & discharge. So the pre hospitalization & post hospitalization expenses has to be borne by the patient.
Q : In case the actual expense exceeds the authorization amount what can/should I do?
This happen many a time, if the expenses exceed than the authorized amount, patient has to pay the difference to the hospital & then reimburse /claim the amount from the TPA.
Q : If the treatment amount is exceeds than the policy amount what should I do?
If the treatment amount is exceeding than the policy amount then the exceeded expenses are to be borne by the patient (one can not reimburse or claim this from the TPA)
Q : If the cashless Authorization is not given by TPA dose it means that I cannot Claim the Amount.
No, it is not so always. In case the policyholder does not get cashless authorization from TPA, it does not mean that he cannot claim the treatment expense. Cashless authorization is given in cases, which are simple & strait forward. If the disease & treatment are beyond these conditions then cashless authorization is not given. Then personal claim can be made.
Q :If treatment exceed more than two months then will I get claim Amount?
If treatment exceeds more than two months after discharge than patient has to take certificate from the Doctor, saying that the treatment is continuing till which time & all these details have to be conveyed to the TPA & by that expenses can be reimbursed.