Please get the photocopies of the following documents for your convenience:

• TPA E-card or Policy
• PAN Card
• Aadhar Card
• Latest passport size photograph
• Doctor’s Consultation Paper
• Relevant Investigation Reports
• Employee Id (If corporate policy)

• In case of a planned admission, a prior approval from your TPA is a must to avail the cashless facility.
• In case of emergency/unplanned admission, the patient will need to pay the requisite deposit amount and then seek approval from the TPA.
• Please note the cashless facility is subject to the terms and conditions applicable in the policy.
• The hospital is not responsible for the refusal/denial/partial approval on the part of the TPA for cashless/reimbursement of claims made by the patient.

Patient hereby would have to clear all the hospital bills (before discharge):

• a. In the event that the insurance claim i.e. the cashless facility is fully denied
• b. If partial payment approval is received from the insurance company
• c. For the payment of non-medical items
• d. For the higher package voluntarily opted by the patient/patient relative
• e. For equipment charges/consumables not covered by the insurance company

Before Admission:

• Pre -Authorization - The patient/relative needs to get the pre-authorization form filled by the treating doctor.
• The documents and the duly filled pre-authorization form are to be submitted to the TPA via email. On receipt of the details, the TPA sends either an approval or a query is raised.
• Once the approval is received, the patient/relative is informed about the same. In case of a query – The TPA desk helps the patient to respond to the query with the help of doctors and get the case approved.
• In case where part approval is received or certain conditions are highlighted by the TPA, the same is conveyed/explained to the patient/relative.

On Admission:

• The patient gets admitted by paying a security deposit and the balance deposit amount (in case where partial approval is received).
• In case where the patient declares the insurance status at the time of admission, the admission is done by collecting the deposit amount, and the patient is directed to the TPA desk to complete the TPA formalities. This process can be done by the relative. On receipt of the approval, the same is applied to the patient’s “In-patient account”.
• In a 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.
• Interim Approvals: For long-stay patients - Interim bills are forwarded to the TPA for enhancement. The response received from the TPA in the form of Approval or Query is then applied or responded back.

At Discharge:

• The final bill and the discharge summary are forwarded to the TPA for the final approval once the patient is ready for discharge.
• There can be a 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 the hospital may be in the range of 1 to 5 hours (approx) depending on the case. In case the patient wishes to take discharge before the approval arrives, the same can be done by settling the bill. The patient could then claim from the TPA directly. 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.

Some More information:

1. Non-medical expenditures, room rent capping & copayment apply to certain cases. Kindly understand the same before the admission.

2. Room rent is applicable on the day of discharge. Up to 6 hours is counted as half a day. 6 hours & above up to 24 hours is counted as one day.

3. The deposit amount (if any) paid by the patient will be refunded within one week after discharge.

4. The hospital is not responsible for the refusal/denial on the part of the TPA for reimbursement of claims made by the patient.

5. The original reports and the discharge summary will be handed over to the TPA/Insurance Company.

6. Admission in the hospital is subject to the availability of the bed.

7. The hospital authority is entitled to share data/records related to admission with representatives/agents from the Insurance Company, TPA, or employer.

Kindly contact us on: 020 30717977 (9 am to 8.00 pm) Email: abmh.tpa@adityabirla.com