With the concept of TPA (THIRD PARTY ADMINISTRATOR) we at Anand Hospital & Research Centre provide complete cashless treatment for patients covered under the Insurance Companies. TPA department at Anand Hospital & Research Centre maintains databases of the various health Insurance companies for the cashless settlement for the patients.The individual who is insured gets an ID card issued by the TPA. At the time of admission the policyholder can flash the Photo ID-Card as a part of identification and receive excellent health services under one roof. Treatment at our hospital is given as per the terms & conditions of the policy.
Guidelines for TPA / Cashless Treatment Facility
The essence of cashless hospitalization is that the insured individual needs not to make an upfront payment to the designated empanelled hospital for treatment. To avail cashless benefit without any inconveniences you need to go through the following:
You are advised to confirm with our TPA Desk whether your TPA is registered with us or not.
- TPA Desk of Anand Hospital would facilitate the documentary – requirements of your TPA / Corporate but in no way can influence their decision about cashless treatment.
- To avail the cashless benefit, all relevant documents e.g. Voter’s ID Card / Driving License / PAN Card, ID Card issued by the TPA, current policy document to be submitted at the TPA Desk by the patient’s relatives.
- The photocopy of the TPA ID card or insurance policy is retained by TPA Desk while the patient starts receiving necessary medical treatment.
- During admission the patient/ relative fulfils the required formalities like filling up the necessary forms. Please do not suppress any facts which may lead to further complications.
- The coordinator / attending Doctor fills up pre authorization form (duly signed by the patient / patient relatives) and forwards it to the concerned TPA by fax / mail within 24 to 48 hours of hospitalization of the patient.
- The coordinator at the TPA desk does regular follow-up with the concerned TPA and waits for the initial approval letter of the patient. Pre- authorization form will be filled up and sent to respective TPA / Corporate up to 5 pm on all working days. Admission after 5 pm on working days and on holidays, pre-authorization forms will be sent to the TPA on the next working day.
- In case your TPA has authorized cashless transaction for your treatment at Anand Hospital, you will be required to pay the inadmissible charges (the difference between the actual bill amount and the TPA approved amount) at the time of discharge. Details will be available at the TPA Desk.
- At the time of admission, you have to give a voluntary undertaking that in the event of denial of cashless treatment facility by your insurance company, you will have to clear the entire bill before discharging your patient.
- For any change of bed category during the course of treatment, the difference in amount in comparison to your sanctioned amount will be charged at the time of discharge.
- You have to visit your TPA Desk regarding the latest status on approval and denial of the cashless facility from 9 am to 7 pm on all working days. This needs to be continued till the time of discharge.
- Patient / attendant has to pay the advance deposit if cashless approval does not come within 24 hours of sending of pre-authorization form.
- Once discharge is finalized, a copy of the discharge summary is sent to the concerned TPA Office. Usually they take 2 – 3 hours to send the final approval. Patient can leave the hospital only when the final approval comes from the respective TPA.
- At the time of discharge patient relatives will get the photocopy of all the reports. Original reports and bills shall be sent to the concerned TPA.
- Any patient under the cashless facility can be discharged at any point of time after paying the full amount of final bill. The amount will be refunded incase if the approval reaches the TPA Desk .In such cases patient / attendant should take information regarding final approval within 24-48 hours of discharge, from the TPA help desk for refund.
- Patient’s relatives are advised to keep themselves updated on the latest status of their respective outstanding bill amount.
- Cashless discharge process will be done on the same day if advice for discharge is given before 2.00 p.m or else next day.
