INSURANCE Cos.
- Apollo Munich Health Insurance Co.Ltd.
- Bajaj Alliance General Ins.Co.Ltd
- Future Generali India Insurance Co.Ltd
- HDFC Ergo General insurance Co.Ltd
- ICICI Lombard General Ins.Co.Ltd.
- ICICI Prudential Life Ins.Co.Ltd
- Iffco Tokio General Insurance Co.Ltd
- Reliance General Insurance Co.Ltd.
- Religare Health Insurance Co.Ltd.
- Star Health & Allied Ins.Co.Ltd
INTERNATIONAL SERVICE PROVIDERS
- Aetna International
- Asia Rescue Medical Services
- Axa Assistance India Pvt.Ltd.
- Bupa International
- East West Rescue Medical Services
- Europ Assistance India
- Exotic Tours
- Hello Health Services Pvt.Ltd.
- International SOS Medical Services
- Meera Rescue Medical Services
- Star Destination
- Vanbreda International
(Bombay Hospital Reserves the right to deny the
Cashless Facility to any of the Card Holders of Above
Mentioned TPA’s.)
Hospitalization benefit for TPA Patients
Patients can avail of the benefit of Cashless hospitalization
at Bombay Hospital & Medical Research Centre if the TPA
that the patient is covered by is tied up with the hospital.
How to identify your TPA?
There are several ways to identify your TPA:
- The TPA will issue you an identity card which will
indicate the name of your TPA.
- On your insurance policy, on the lower left hand corner
of the policy, the name of the TPA will be printed.
- Your insurance agent will be able to inform you
accurately.
Where to get TPA Pre authorization forms?
The pre authorization forms of TPA tied up with the hospital
can be collected from the marketing department.
Important points to Note:
Possessing a TPA identity card does not automatically entitle
the patient to get Cashless benefit. A certain defined
procedure for obtaining sanction from the TPA has to be
followed.
Admission process:
- For all elective / planned admissions, Cashless approval
should be obtained from the TPA atleast 2 days prior to
the date of admission.
- Marketing department will assist you in faxing the duly
filled pre authorization form of the TPA (along with the
latest policy copy and positive investigation reports.)
- At the time of admission, even if the TPA has approved
cashless, a refundable security deposit of Rs. 5000/- is
to be paid by the patient.
- Incase the bed class / room specified in the
authorization letter is not available, the patient will
be admitted in the higher or lower class as per choice
of patient. In case of admission in the higher class,
patient will have to pay the difference in the charges
from the date of admission.
During hospitalization:
- The patient must give a proper and true medical history
to the doctor at the time of filling in the pre
authorization form, since any discrepancy may result in
the denial of the claim and cancellation of the
approval.
- In case the patient is transferred to ICU/ICCU/ Recovery
room and wants to retain the original bed then patient
will have to keep an additional security deposit,
depending on the class and number of days in
ICU/ICCU/Recovery Room, as the TPA does not pay for dual
occupancy.
- Receiving an authorization letter for Cashless benefit
is only tentative. If the claim is denied for any reason
by the insurance company during the course of treatment
or after patient is discharged, patient will be
responsible for payment of the hospital bills, as per
the undertaking which the hospital collects at the time
of registration under respective TPA.
- If the patient bill exceeds the sanctioned amount, an
estimate for the additional amount will be sent through
the marketing department to the TPA. However, it is
primarily the responsibility of the patient / relative
to keep track of the bill. If no enhancement is received
from the TPA, the patient will have to pay for the bill
amount over and above the sanctioned amount by the TPA.
Discharge process:
- The hospital will retain Rs. 5000/- refundable deposit
for every one lakh of the sanctioned amount as deposit
until the hospital receives complete payment from the
TPA. On settlement of payment from the TPA, the patient
will be intimated by SMS regarding procedure of refund
of deposit.
- The hospital shall collect payment for all
exclusions / non-medical expenses / surcharge, if
they are not covered by TPA at the time of
discharge.
- No original hospital document’s or reports will be given
to patient, since these are sent by the hospital to TPA
along with the bill for reimbursement. Xerox copies of
the same can be taken by the relative at his own cost.
- At the time of Discharge, the patient can collect a copy
of detailed bill / summary from the accounts department.
- Any pending reports or films should be collected from
the marketing department within 10 days of discharge.
Denial process:
On denial of Cashless hospitalization by the TPA, the patient
will be treated as a cash paying patient and will have to
make the necessary payments as per hospital policy.
For Reimbursement:
For patients who do not avail the benefit of Cashless
hospitalization or whose claims are denied for Cashless,
please contact your respective TPA along with patient’s
Discharge card, all Original reports, claim form of
insurance company and hospital bills (to be attested by Dy.
Medical Suptd. / Officer on Special Duty) for reimbursement.
If the Indoor case papers are required, kindly make an
application in the Medical Suptd. Office / Dy. Medical
Suptd. Office during working hours.
Bombay Hospital Reserves the right to deny the
Cashless Facility to any of the Card Holders of Above
Mentioned TPA’s.
Marketing department will assist you and guide you in the
process of obtaining the cashless facility from the TPA /
Insurance company. However the primary
responsibility of obtaining the authorisation would be
of the patient / relative.
