Information for Patients Covered Under Insurance
Thank you for choosing Helios Hospital for your healthcare requirements. For your better understanding and to facilitate a smooth insurance process, we have prepared a note on how the insurance process works.
General instructions: please provide us with details of your insurance policy on admission. The following documents are required at the time of admission:
- Your TPA card
- In the absence of your TPA card please provide the following:
- Name of your TPA/Policy copy and number for non-corporate patients
- Employee ID card, name of your company for corporate patients
- Government ID proof – Voter ID card / Passport / Driver’s Licence / PAN card / Aadhar card / etc.
- Kindly check & confirm your eligibility of room rent with your TPA as proportionate charges will be applicable if opting for higher room category
- If estimation is above 1 Lakh, PAN card is mandatory (Patient/Beneficiary)
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- Please note that Helios Hospital is a mere facilitator between you and the (Third Party Administrator) TPA / Insurer. The hospital has entered into an agreement with your TPA/Insurer in order to provide cashless facility to patients registered with various TPAs.
- A stay of 24 hours in the hospital is mandatory for the patient to obtain approval from the TPA. Exceptions to this are patients getting admitted for Chemotherapy (The insurance coordinator will give you more information on such procedures).
- On admission, the hospital conducts an assessment of your medical condition and the recommended plan of treatment is sent to the medical team at the TPA/Insurer to initiate the necessary approvals (Pre-authorization).
- The medical team at TPA/Insurer will determine the following:
- Whether the condition requires admission & the treatment plan is covered by your health insurance policy
- The amount you are insured for, and other terms and conditions for your insurance policy
- The TPA/Insurer will finally approve or deny cashless treatment. In case of denial of cashless facility, the agreed tariff rate between TPA/Insurer and hospital will not be applicable.
- Helios Hospital is not responsible for denial or partial approval and cannot influence the process other than providing required documentation to the TPA/Insurer.
- Normal turnaround time for pre-authorization: 4 to 6 hours during working days. The turnaround time is higher during non-working days.
- You are advised to thoroughly check all the terms and conditions of your insurance policy to avoid any misunderstanding.
- Please note that the “pre-authorization” by TPA/Insurer does not automatically guarantee that the final bill is approved.
- If the pre-authorization request is not approved by your TPA/Insurer for any reason you will have to settle the bill in full and claim the amount from the TPA. Some items billed during hospitalization may not be covered under your insurance contract. Irrespective of the approved amount these items will not be payable by your TPA/Insurer. Expenditure towards such items will have to be settled directly by you.
- Deposit of Rs.5000/- is being collected for such expenses
- Kindly pay 50% of the estimated amount as deposit of non-approval
- 5% of the estimated amount to be paid in case of surgery
- If the course of treatment changes or there is a change in the diagnosis of the patient after the pre-authorization process, it is possible that the insurance company will not cover the new diagnosis submitted if the diagnosis is not covered under the patient’s policy.
- Interim enhancement: In case there is a change in the patient’s condition leading to increase in the bill of the patient as compared to the initially approved amount, an interim bill and progress notes of the patient will be sent to the TPA/Insurer for further confirmation and approval. It is for the TPA/Insurer to approve or deny the changes based on the opinion of their own medical team and your particular policy. The approval can be denied even at this stage.
- Final approval: At the time of discharge the process of obtaining final approval starts only if the final bill and the discharge summary are sent to the TPA/Insurer. Possible delays in obtaining the final approval include:
- Query pertaining to bill, diagnosis or length of stay
- If the discharge is being processed after 6pm and on holidays
- The hospital does not have control over the final approval process and can only request the TPA/Insurer to expedite the process. Approval by TPA/Insurer takes 3-5 hours on weekdays and 8-24 hours on Sunday/holidays. Most TPAs do not function post office hours and on weekends and holidays. You could intervene by requesting the TPA/Insurer to expedite the process.
- Please note that although you have sufficient insurance coverage there is no guarantee that TPA/Insurer will approve the full treatment cost. In such cases the difference between billing and approved amount along with non-medical expenses and co-payment amount would need to be settled directly by the patient.
- Helios Hospital will assist you to the best extent possible from pre-authorization to final bill amount from your TPA/Insurer. However in order to reduce the approval time we advise you to follow up with the TPA/Insurer from your end too. Our Insurance advisor would be glad to provide you with the necessary contact numbers and email address of your TPA/Insurer.
Helios hospitals has empanelment with the following Insurance companies and TPA’s.
1.
VIDAL HEALTH INSURANCE
2.
FUTURE GENERAL HEALTH INSURANCE
3.
MEDSAVE HEALTH CARE
4.
STAR HEALTH INSURANCE
5.
MAX BUPA HEALTH INSURANCE
6.
FOCUS HEALTH INSURANCE
7.
CIGNA TTK HEALTH INSURANCE
8.
VIPUL MEDCORP TPA PVT LTD
9.
ICICI LOMBARD HEALTH INSURANCE
10.
CHOLA MS HEALTH INSURANCE
11.
PARK MEDICLAIM TPA PVT LTD
12.
PARAMOUNT HEALTH
13.
MEDI ASSIST INDIA TPA PVT LTD
14.
ADITYA BIRLA HEALTH INSURANCE
15.
HDFC ERGO HEALTH INSURANCE
16.
APOLLO MUNICH HEALTH INSURANCE
17.
SAFEWAY TPA PVT LTD
18.
UNIVERSAL SOMPO HEALTH INSURANCE
19.
HEALTH INSURANCE TPA OF INDIA LTD
20.
FAMILY HEALTH PLAN INSURANCE TPA LTD
21.
RELIGARE HEALTH INSURANCE
22.
GOOD HEALTH INSURANCE TPA LTD
23.
MEDICARE INSURANCE TPA LTD
24.
RELIANCE HEALTH INSURANCE
25.
ERICSON INSURANCE TPA PVT LTD
26.
BAJAJ ALLIANZ HEALTH INSURANCE
27.
NATIONAL INSURANCE CO LTD
28.
THE NEW INDIA ASSURANCE CO LTD
29.
THE ORIENTAL INSURANCE CO LTD
30.
UNITED INDIA INSURANCE CO LTD
31.
RELIANCE GENERAL INSURANCE
32.
DEDICATED HEALTHCARE SERVICES TPA PVT LTD
33.
LIBERTY GENERAL INSURANCE
34.
EDELWEISS HEALTH INSURANCE
35.
MEDIWHEEL HEALTH INSURANCE
36.
TATA AIG HEALTH INSURANCE
37.
ALANKIT INSURANCE TPA LTD
38.
SUNRISE MEDICORP PVT LTD
39.
ROYAL SUNDARAM INSURANCE
40.
MEDEAZ HEALTH ASSISTANCE
41.
ACKO GENERAL INSURANCE
42.
IFFCO TOKIO HEALTH INSURANCE
43.
MDINDIA HEALTH INSURANCE TPA PVT LTD
44.
HERITAGE HEALTH TPA PVT LTD
45.
MAGMA HDI GENERAL INSURANCE CO LTD
46.
BHARTI AXA HEALTH INSURANCE
47.
KOTAK GENERAL INSURANCE
48.
PROGNOHEALTH
49.
ROTHSHIELD HEALTHCARE TPA
50.
GENINS INDIA INSURANCE TPA LTD
TIE UPS
1.
IIT TIRUPATI
2.
SRIKALAHASTHI PIPES LTD
More coming…..
Are you insured?
If not, take a health insurance immediately. As medical care advances and treatments increase, health care costs also increase. The purpose of health insurance is to help you pay for health care. It protects you and your family financially in the event of an unexpected serious illness or injury that could be very expensive. Lack of insurance is a fiscal burden for them and their families in case of an unexpected medical emergency. So take the decision. Get insured!!