If the beneficiary wishes to avail of cashless treatment, they should have the cashless authorization request form duly filled and signed by the Treating Doctor and the beneficiary.
Cashless/ Pre-authorization form can be obtained from the Help Desk by producing Insurance Policy papers/TPA Card.
i) The first step is to consult with the doctor and obtain a prescription with patient's details, diagnosis, treatment plan, and estimated cost of treatment.
ii.) In case admission in emergency connect with the Treating Consultant immediately for pre-authorization formalities
iii.) Obtain a pre-authorization from the Hospital Insurance/TPA Helpdesk ( Room No. 8, Admission Building) and ask the Consultant to fill in the required details.
Submit the Pre-authorization form at the Helpdesk which will be sent to your Insurance /TPA service provider. The insurance company or TPA will review the pre-authorization request and determine whether the treatment is necessary and covered under the policy.
Based on the review, the insurance company or TPA will approve or deny the pre-authorization request. If the request is approved, the beneficiary can proceed with the treatment. If the request is denied, the beneficiary will need to pay for the treatment out of their pocket.
The insurance company or TPA may raise queries before providing pre-authorization for medical treatment. This is a standard practice to ensure that the treatment being sought is necessary and covered under the policy.
Please check with the Treating Consultant - queries related to the diagnosis, treatment plan, estimated cost of treatment, and other relevant details.
In some cases, the insurance company or TPA may require additional documents or information to assess the claim. For example, they may ask for medical reports, previous treatment history, or a second opinion from another doctor. The beneficiary need to provide these documents before the insurance company or TPA can provide pre-authorization.
It is important for the beneficiary to cooperate with the insurance company or TPA and provide all the necessary information to ensure a smooth pre-authorization process. If the beneficiary or hospital is unable to provide the required information or documents, it may delay the pre-authorization process and the start of the treatment.
Therefore, it is recommended that the beneficiary keeps all relevant documents and medical reports handy to provide them when required.
The time taken for pre-authorization approval to come to the hospital may vary depending on several factors, such as the complexity of the treatment, the insurance company or TPA's workload, and the completeness of the pre-authorization request. However, in general, it may take anywhere from a few hours to a few days for the pre-authorization approval to come to the hospital.
To minimize the time taken for pre-authorization approval, it is important to ensure that the pre-authorization request is complete and contains all the necessary information, such as the patient's details, diagnosis, treatment plan, and estimated cost of treatment. The request should be submitted well in advance of the planned treatment to allow sufficient time for the review and approval process.
The beneficiary can also follow up with the insurance company/TPA to check the status of the pre-authorization request and ensure that it is being processed in a timely manner. It is important to note that pre-authorization approval is not guaranteed, and the beneficiary may need to bear the cost of the treatment if the request is denied. Therefore, it is important to understand the terms and conditions of the insurance policy and the pre-authorization process to avoid any unexpected expenses.
The insurance company or TPA will communicate the decision to the hospital, and the hospital will proceed with the treatment based on the decision.