Mediclaim

Mediclaim (Surcharge is not applicable for all the patients)

Insurance/ TPA Hospitalization Process Information

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 pre-authorization forms

- Marketing Department -

BH Old Building Ist floor - 8am to 8pm
CMO Office, Ist floor MRC - 8am to 6 pm
New Wing 14th floor – 9am to 6pm.
MRC 6th floor – 10am to 6pm
Download from our website –www.bombayhospital.com

Important points to note

Marketing Department will guide you through the pre-authorization procedure. However, the Department is only a facilitator and can in no way influence the decision on the approval. Your TPA may not grant approval due to the following reasons –

If the information given in pre-authorization form is insufficient to approve the request.
If the ailment for which you are hospitalized is not covered in your policy.
If you have exhausted the sum insured for the year.

Room Eligibility:

For Govt. Insurance companies, 1% of your sum insured is your room eligibility (e.g. If sum insured is Rs. 5 lacs, room eligibility would be Rs. 5000/-)
For Private Insurance companies, kindly confirm with your Insurance company.
For patients having Corporate Insurance, kindly confirm with your HR Department.

Documents required for Cashless

Complete filled form by the Consultant & Accounts Dept.
First Consultation letter from the Consultant.
Positive Investigation reports for the current ailment.
Latest policy copy / TPA card copy.
Photo Identity of the patient.
Passport size photograph of the patient.
KYC of the proposer.

Admission Process –

In case where the patient declares the insurance status at the time of admission, the patient is given the TPA form to complete the TPA formalities. On receipt of the approval the same is applied to the patient’s “In-patient account”.
In situation where the patient has applied for the TPA approval, however, no reply/approval has been received by the hospital, then the patient gets admitted by paying the full requisite deposit.
The patient gets admitted by paying 5% security deposit and the balance deposit amount (in case where partial approval is received).
Interim approval : For long stay patient-Interim bills are forwarded to the TPA for enhancement. Response received from the TPA in the form of Approval or query is then applied or responded back.

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 I 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 final bill and the discharge summary are forwarded to the TPA for the final approval once the patient is for discharge.
There can be query at the time of discharge because of which the discharge can get delayed.
The time taken for the final approval to be received by hospital may be in range of 2 to 4 hrs (approx) depending on the case. In case the patient wishes to take discharge before the approval arrives, the same can be done by keeping the entire bill amount as deposit. The same will be refunded to you in seven working days, once we receive the approval from TPA. The patient must wait for the final approval even if the sum insured is exhausted.
TPA formalities cannot be started on the day of discharge.
Non medical expenditures, room rent capping & co-payment are payable at the time of discharge.
The excess deposit amount (if any) paid by the patient will be refunded within 7 working days after discharge.
Deductions by TPA after the approval is given (Post Discharge) – Incase the TPA/Insurance does not pay the approved amount; the balance outstanding is settled with the refundable security deposit.
The hospital is not responsible for the refusal/denial on the part of the TPA for reimbursement of claims made by the patient.
The original reports and the discharge summary will be handed over to the TPA/Insurance Company.
The hospital authority is entitled to share data/records related to admission with representatives/agents from the Insurance Company or TPA.

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.

Re-imbursement Process –

Re-imbursement form can be available from the Insurance Company website or contact your agent
Form can be filled by your treating doctor and attested by the Medical Administration, 2nd floor, MRC Building between 10am to 6pm.
Indoor case papers can be collected from the Medical Records Department with prior approval of Medical Administration.

Documents required –

Part A & Part B forms of respective Insurance Companies
All original investigation reports
Original Bills
Indoor case papers (if required)

For queries, you may call Tel.No. 022-40511430/40511235 between 10 am to 4pm

Mediclaim

Bombay Hospital is the one of the Tertiary Care Hospital to be recognized by the following Govt. Insurance Companies (GIPSA) for cashless –

New India Assurance Co.Ltd.

Oriental Insurance Co.Ltd.

National Insurance Co.Ltd.

United India Insurance Co.Ltd.

Kindly confirm with your policy copy or agent, as to which TPA would be processing your cashless hospitalization benefit.

List of TPA’s / Insurance companies / International Insurance Companies

TPA’s

Family Healthplan Ltd

Good Health TPA Services Pvt Ltd.

Health Insurance TPA

Health India - Bhaichand Amoluk Pvt.Ltd.

Medvantage Insurance TPA Pvt.Ltd.

Medi Assist India Pvt.Ltd

MD India Healthcare Services

Medsave Healthcare Ltd.

Park Mediclaim TPA Health Services

Paramount Health Services Pvt.Ltd.

Raksha TPA Pvt. Ltd.

Safeway TPA Services Pvt.Ltd

Vidal Health TPA Pvt Ltd.

Volo Health Insurance TPA Pvt.Ltd

Ericson Insurance TPA Pvt. Ltd.

Insurance Cos.-

Aditya Birla Health Insurance Co. Ltd.

Bajaj Alliance General Ins. Co. Ltd

Care Health Insurance Ltd

East West Assist Insurance.TPA 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

Niva Bupa Health Insurance Co.Ltd.

Reliance General Insurance Co.Ltd.

Star Health & Allied Ins.Co.Ltd

SBI General Insurance Co.Ltd.

TATA AIG General Insurance Co.Ltd

Universal Sompo General Insurance Co.Ltd

NAVI General Insurance Co. Ltd.

Go Digit General Insurance Co. Ltd.

Liberty General Insurance Co. Ltd.ricson Insurance TPA Pvt. Ltd.

Galaxy Health Insurance Co. Ltd.

International Service Providers

Asia Rescue Medical Services

Asian Travel Medical Services

AXA Assistance India Pvt. Ltd.

Bupa International

CIGNA Global

East West Rescue Medical Services

Europe Assistance

International SOS Medical Services

Meera Rescue Medical Services

(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.

Marketing Department

Address:

1st floor Bombay Hospital Building,
New Marine Lines, Mumbai - 400 020.

Telephone No:

022-40511430, 022-40511235

Timing:

Monday to Saturday - 8 am to 8 pm
Sundays and Public Holidays - 9 am to 5 pm

Website:

www.bombayhospital.com

Email:

bhtmktg@gmail.com

Jaipur

Indore

Mediclaim

Mediclaim (Surcharge is not applicable for all the patients)

Insurance/ TPA Hospitalization Process Information

Hospitalization benefit for TPA Patients

How to Identify Your TPA?

Where to get pre-authorization forms

- Marketing Department -

Important points to note

Room Eligibility:

Documents required for Cashless

Admission Process –

During hospitalization:

Discharge Process –

Denial process:

Re-imbursement Process –

Documents required –

Mediclaim

New India Assurance Co.Ltd.

Oriental Insurance Co.Ltd.

National Insurance Co.Ltd.

United India Insurance Co.Ltd.

List of TPA’s / Insurance companies / International Insurance Companies

TPA’s

Family Healthplan Ltd

Good Health TPA Services Pvt Ltd.

Health Insurance TPA

Health India - Bhaichand Amoluk Pvt.Ltd.

Medvantage Insurance TPA Pvt.Ltd.

Medi Assist India Pvt.Ltd

MD India Healthcare Services

Medsave Healthcare Ltd.

Park Mediclaim TPA Health Services

Paramount Health Services Pvt.Ltd.

Raksha TPA Pvt. Ltd.

Safeway TPA Services Pvt.Ltd

Vidal Health TPA Pvt Ltd.

Volo Health Insurance TPA Pvt.Ltd

Ericson Insurance TPA Pvt. Ltd.

Insurance Cos.-

Aditya Birla Health Insurance Co. Ltd.

Bajaj Alliance General Ins. Co. Ltd

Care Health Insurance Ltd

East West Assist Insurance.TPA 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

Niva Bupa Health Insurance Co.Ltd.

Reliance General Insurance Co.Ltd.

Star Health & Allied Ins.Co.Ltd

SBI General Insurance Co.Ltd.

TATA AIG General Insurance Co.Ltd

Universal Sompo General Insurance Co.Ltd

NAVI General Insurance Co. Ltd.

Go Digit General Insurance Co. Ltd.

Liberty General Insurance Co. Ltd.ricson Insurance TPA Pvt. Ltd.

Galaxy Health Insurance Co. Ltd.

International Service Providers

Asia Rescue Medical Services

Asian Travel Medical Services

AXA Assistance India Pvt. Ltd.

Bupa International

CIGNA Global

East West Rescue Medical Services

Europe Assistance

International SOS Medical Services

Meera Rescue Medical Services

Marketing Department

Address:

Telephone No:

Timing:

Website:

Email: