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 TPA Pre authorization forms?
The preauthorization 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.
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:
- For all elective/ planned admissions, Cashless approval should be obtained from the TPA at least 3 – 4 days prior to the date of admission.
- Marketing department will assist you in sending the duly filled pre authorization form of the TPA (along with the necessary documents).
- 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 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 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 messages or mail regarding procedure of refund of deposit.
- The hospital shall collect payment for all exclusions / non-medical expenses, if they are not covered by TPA at the time of discharge.
- No original hospital document’s or reports will be given to the patient, since these are sent by the hospital to TPA along with the bill for reimbursement . Xerox copies for the same will be given to the patient.
- 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.
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.
List of TPA’s / Insurance companies/International Insurance Companies
TPA’s
INSURANCE Cos.-
- Aditya Birla Health Insurance CoLtd -
Click to download the pre authorisation form - Bajaj Alliance General Ins.Co.Ltd -
Click to download the pre authorisation form - Care Health Insurance Ltd -
Click to download the pre authorisation form - East West Assist Insurance.TPA Ltd -
Click to download the pre authorisation form - Future Generali India Insurance Co.Ltd -
Click to download the pre authorisation form - HDFC Ergo General insurance Co.Ltd -
Click to download the pre authorisation form - ICICI Lombard General Ins.Co.Ltd. -
Click to download the pre authorisation form - ICICI Prudential Life Ins.Co.Ltd -
Click to download the pre authorisation form - Iffco Tokio General Insurance Co.Ltd -
Click to download the pre authorisation form - Niva Bupa Health Insurance Co.Ltd. -
Click to download the pre authorisation form - Reliance General Insurance Co.Ltd. -
Click to download the pre authorisation form - Star Health & Allied Ins.Co.Ltd -
Click to download the pre authorisation form - SBI General Insurance Co.Ltd. -
Click to download the pre authorisation form - TATA AIG General Insurance Co.Ltd -
Click to download the pre authorisation form - Universal Sompo General Insurance Co.Ltd -
Click to download the pre authorisation form
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.)
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
New Marine Lines, Mumbai - 400 020.
Sundays and Public Holidays - 9 am to 5pm