Our hospital has a tie-up with the leading health insurance providers to facilitate a cashless admission and treatment for patients covered under the insurance. You do not have to worry about finances in case of hospitalization, thus giving you peace of mind. You are assured of receiving the best medical treatment when you know you are adequately covered.
Health Insurance Policies Provide benefits for hospitalization for illness, disease or Accident.
As per Insurance Policy, 24 hours inpatient stay is mandatory, except for specified day care procedures. (Please refer your Policy conditions or contact the Corporate HR for Policy terms and conditions). Preliminary Investigations/evaluation are generally not covered under Insurance.
The Insurance Companies do not pay for Non-medical expenses like Toiletries, Cosmetic items, buds, masks, Housekeeping charges, Admission Charges, attendant/Registration charges, Medical Certificate, MLC charges, Attender Room charges etc. (For a detailed list, refer to Insurer guidelines/Copy with Insurance Helpdesk).
In case the patient stays in a room beyond his/her entitled limit (1% of Sum Insured for Normal room and 2% for ICU- inclusive of room & nursing charges, for most companies), the Insurer/TPA may also deduct a proportionate amount from the Total Bill amount and NOT JUST THE ROOM RENT DIFFERENCE. The Patient will be expected to bear this amount.
The TPAs/ Insurance companies may deny Cashless based on certain exclusions like pre-existing ailments, policy exclusions, under the influence of alcohol, AIDS/ HIV related treatments, Sum Insured Exhausted, psychiatric treatments etc.
Patient has to get the pre-authorisation form from the Insurance Helpdesk or from private clinic areas. In case of admissions through Casualty Counters, the insurance helpdesk is to be approached within close of office Hours on the Subsequent day and formalities to be completed.
The Pre-authorisation form has to be duly filled in by the patients and the treating doctor and handed over to the Insurance helpdesk. The pre-authorisation form has to be accompanied by the TPA ID card / Policy copy of the patient, Photo ID proof (PAN CARD, DL, Ration card, Aadhaar card), supportive investigation reports & outpatient consultation papers.
In case of RTA / accident, patient has to provide the following: FIR / MLC / AR to be provided. Narration of accident - when, where & how, should be clearly provided through a letter. Consumption of Alcohol / Drugs – a letter from the FIRST TREATING DOCTOR, certifying whether the patient was under the influence of Drugs / Alcohol at the time of accident is to be provided.
If SRMC is not the first treating hospital visited by Patient, please produce a letter from first treating doctor. Insurance Companies/TPAs may take up to 24 hours for Approval on weekdays and this can extend up to 2/3 days if any queries are raised by the TPA/ Insurance Co. However, by constantly following up with the Insurer, we have a turnaround time of less than 3-6 hours for almost 85% of the cases any day.
UNTIL RECEIPT OF THE APPROVAL FROM THE TPA, THE PATIENT WILL BE TREATED AS CASH PATIENT AND LIABLE TO PAY INITIAL DEPOSIT AND OTHER DEPOSITS. (The same can be adjusted and refunded at the time of discharge). After receipt of approval, credit shall be extended and the same will be reviewed and Interim requests for enhancement may be sought from TPA or the patient may be asked to make payments.
The Final discharge process may take up to 4 hours from the time of receipt of Final Bill and discharge Summary at the Insurance helpdesk and may extend if any queries are raised. It shall be our endeavour to follow up with the TPA and facilitate discharge on the same day, for all receipts before 12 NOON.
It is generally not advisable to plan discharges on Government Holidays and Sundays, as Most of the TPAs do not work on these days and follow-up becomes difficult. At the time of discharge, if the bill amount exceeds the approved amount, further approval may be required for the enhanced amount or the patient should pay the difference. If the Final approval amount is pending from Insurance even beyond 8 PM, the patient has to PAY THE FULL AMOUNT as a deposit and obtain discharge. Once the approval is received, refund shall be made.
Please note that the Hospital is not to be held responsible for delays in Final approvals from the TPA/ Insurer, as they are a chosen by the Insured. Refund is immediate if the payment by cash (subject to limit set by SRMC, from time to time). Else, if it has been by Debit/Credit card, we shall wait for 2 days to check realization before a refund is made.
For the amount beyond the hospital limits, refund shall be by way of DD / NEFT Insurance Helpdesk is only a facilitator and is not to be held liable for the approval / denial of your Preauthorization / Enhancement request. This is at the sole discretion of the respective TPA/ Insurer, based on policy terms and conditions. If in spite of our effective follow ups, the approval gets delayed from TPA side, the hospital is not to be held responsible. The approval rights vest with the Insurer / TPA.
Listed here are the Insurance providers with whom we have established a tie-up for an effective and quick cashless facility for patients.
- Star Health and Allied insurance
- Vidal Health TPA
- Good Health Insurance TPA
- Family health Plan Ltd
- Heritage Health Insurance
- Reliance General Insurance
- Religare/Care health Insurance
- Max Bupa Life insurance TPA
- ICICI Lombard
- Erickson Insurance TPA Pvt Ltd
- Medi assist-Op Health Checkup
- MD India Health Care Services
- 15 TNNHIS-Employees
And there is a lot more under process insurance companies like
- Health India
- Genius India
- Medi Assist TPA
- Vipul Medcopr Insurance
- Medsave health Care
- United Health Care
- Iffco Tokio General Insurance
- Raksha Health Insurance
- Manipal Cigna Health Insurance
- Paramount health Service