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Medical Insurance & TPA Services

Cashless hospitalization means as a policyholder, one will be able to avail medical services at designated hospitals and bills will be settled through TPAs (third party administrators)rather than direct out-of pocket-payment

Medical Insurance & TPA Services

Policies & Procedures

P. D. Hinduja Hospital is empanelled with most of the reputed insurance providers. We also accept employer covered insurance services Cashless facility is subject to the conditions and terms in the policy.

Medical Insurance & TPA Services

Cashless hospitalization means as a policyholder, one will be able to avail medical services at designated hospitals and bills will be settled through TPAs (third party administrators) rather than direct out-of pocket-payment.

Pre Admission and Admission Requirements

In case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must apply for approval of the estimated hospital expenses directly by your TPA at least 4-5 days prior to the date of hospitalization.

In case you have not applied for pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Corporate Help Desk (Phone: 022-24460649 / 24447543) will assist you through the pre-authorization procedure. Normal working hours are from 8.00 a.m. to 8.00 p.m., Monday to Saturday and on Sunday / Hospital Holidays from 9.00 a.m. to 5.00 p. m.

However, the Corporate Help Desk is only a facilitator and can in no way influence the decision on the approval. Your TPA may not grant approval due to any of the following reasons:

  • If the ailment for which you are hospitalized is not covered in your policy.
  • If the information contained in pre-authorization form is insufficient to approve the request, though most of the time the TPA will request the hospital if additional information is needed.
  • If you have exhausted the sum assured for that year.

The pre-authorization procedure is detailed below:

Step 1: Establish contact with the Corporate Help Desk at the hospital.

Step 2: At the Corporate Help Desk, you need to present the original Health Insurance card issued to you by your TPA.

Step 3: Collect the pre-authorization forms pertaining to your TPA.

Step 4: Your pre-authorization form will have two sections-

General details on the health insurance policy - to be filled in by you (the Corporate Desk will assist you in case you have any difficulty).

The treatment recommended for you-to be filled in and duly signed by the doctor who is treating you (Do not attempt to fill this section, contact the Corporate Desk in case of any difficulty).

Step 5: Return the completed form to the Corporate Help Desk. along with the copies of the document mentioned in TPA check list. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy.

Step 6: Once the form is complete in all respects, the Corporate Help Desk will upload the documents on the remedinet portal and transmit to the office of your TPA.

Step 7: The Corporate Help Desk will revert to you on the approval/denial status, also status of approval is updated on registered mobile no as well as a display screen is available near the TPA desk in the lobby.

Step 8: At the time of admission, you shall be required to pay differential amount of admission deposit and TPA approval. The differential amount would be refunded on discharge after receiving the final approval as per the final bill. A TPA deposit payment of Rs.7500/- has to be paid on admission, which shall be refunded post discharge, subject to completion of all formalities and payment received by the hospital.

Empanelled TPAs and Insurance

Our empanelled TPA's and Insurance companies may change periodically. Please contact TPA desk for update.