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02223667809
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02223667811 / 7820
Boardline Number
02223671888 / 2888
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Doctor  General  

CASHLESS
Patient Process

Planned Admission

  • In the case of planned admissions, the patient needs to submit the preauthorization form to the TPA help desk at least 7 days prior to the date of admission.
  • The preauthorization form has two parts:
    • General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
    • Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
  • The following documents are required to be submitted:
    • Insurance ID Card
    •  Admission Note
    • Any Relevant Investigations reports  supporting the diagnosis
    • Preauthorization  Form – duly filled up and signed by the treating doctor
    • Photo Id  and address proof of the patient
    • Recent passport size photo of the patient
  • The TPA help desk will be sending these documents to your TPA/insurance company for further processing.
  • The TPA/insurance company can revert with either of the following:
    • Initial Approval – The same will be alerted to you by a phone call
    • Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a telephone call

Emergency Admission

  • In the case of emergency admission, it is our priority to start the patient treatment at the earliest.
  • The cashless process has to be initiated within 24 hrs of the admission.
  • The patient needs to pay a deposit at the time of admission (as per hospital policy based on a type of surgery or class of admission) and that will be refunded to the patient as per the hospital refund policy for the cashless patients.
  • TPA Help Desk will assist you in sending the duly filled pre-authorization form to the TPA / insurance company (along with relevant documents.)
  • The preauthorization form has two parts:
    • General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
    • Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
  • Along with this additional documents are required to be submitted which are as follows:
    • Insurance ID Card
    • Any Relevant Investigations reports  supporting to the diagnosis if any
    • Preauthorization  Form – duly filled up and signed by the treating doctor
    • Photo Id  and address proof of the patient
    • Recent passport size photo of the patient
  • The TPA help desk will be sending these documents to your TPA/insurance company for further processing.
  • The TPA/insurance company can revert with either of the following:
    • Initial Approval – The same will be alerted to you via a phone call.
    • Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a phone call.

During the hospital stay

  • If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the TPA helpdesk to the TPA / insurance company. However, if no enhancement is received from the TPA / insurance company, the patient will have to pay for the bill amount over and above the sanctioned amount.
  • If the TPA / Insurance Company intimates that the Sum insured is exhausted the patient needs to pay for the bill amount above the exhausted amount. The discharge process will however be as a TPA/ Insurance patient.
  • Receiving an authorization letter for Cashless hospitalization is only tentative. The TPA/Insurance Company can deny the claim for any reason during the course of treatment or after a patient is discharged. The 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 / Insurance Company.
  • At all stages the information will be shared with you via phone calls

Discharge Process

  • On the day of discharge the patient’s final bill and discharge summary will be sent to the respective TPA / Insurance Company.
  • On receiving the final approval the patient’s discharge will be completed after taking the refundable deposit on sanctioned amount as a security deposit until the hospital receives complete payment from the TPA / insurance company
  • Patient is required to pay for all non-payable expenses as their policy does not cover the non-payable expenses
  • No original documents or reports of the hospitalization will be given to patient(except films), since these are to be sent by the hospital to TPA / insurance company along with the final bill for the final payment.
  • At the time of Discharge, the patient can collect a copy of final bill from the Billing department.
  • A photocopy of all the reports along with any pending reports can be collected from the Report Counter after 7 days of discharge.
  • After Final payment from the TPA / insurance company the patient will be intimated by phone call.

In case of Denial

On denial of Cashless hospitalization by the TPA / insurance Company the patient will be treated as a cash paying patient.

The TPA/ insurance company may not grant approval due to any of the following reasons:

  • If the ailment for which patient is hospitalized is not covered in their policy.
  • If the provided medical details of the patient is insufficient to approve the request, though most of the time the TPA / insurance company will request the hospital if additional information is needed.
  • If the patient has exhausted the sum assured for that year
  • In these cases the patient has to make the necessary payments as per hospital policy and go for reimbursement.
Planned Admission

Planned Admission

  • In case of planned admissions, the patient needs to submit the preauthorization form to the TPA help desk at least 7 days prior to the date of admission.
  • The preauthorization form has two parts:
    • General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
    • Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
  • he following documents are required to be submitted:
    • Insurance ID Card
    •  Admission Note
    • Any Relevant Investigations reports  supporting the diagnosis
    • Preauthorization  Form – duly filled up and signed by the treating doctor
    • Photo Id  and address proof of the patient
    • Recent passport size photo of the patient
  • The TPA help desk will be sending these documents to your TPA/insurance company for further processing..
  • The TPA/insurance company can revert with either of the following:
    • Initial Approval – The same will be alerted to you by a phone call
    • Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a telephone call
Emergency Admisssion

Emergency Admission

  • In the case of emergency admission, it is our priority to start the patient treatment at the earliest.
  • The cashless process has to be completed??(Initiated) within 24 hrs of the admission.
  • The patient needs to pay a deposit at the time of admission (as per hospital policy based on a type of surgery or class of admission) and that will be refunded to the patient as per the hospital refund policy for the cashless patients.
  • TPA Help Desk will assist you in sending the duly filled pre-authorization form to the TPA / insurance company (along with relevant documents.)
  • The preauthorization form has two parts:
    • General Information – The first part of the form to be filled in by you (TPA Help Desk will assist you in case of any difficulty)
    • Medical information – The second part which is the treatment recommended for you has to be filled in and duly signed by the treating doctor.
  • Along with this additional documents are required to be submitted which are as follows:
    •  Insurance ID Card
    • Any Relevant Investigations reports  supporting to the diagnosis if any
    • Preauthorisation  Form – duly filled up and signed by the treating doctor
    • Photo Id  and address proof of the patient
    • Recent passport size photo of the patient
  • The TPA help desk will be sending these documents to your TPA/insurance company for further processing.
  • The TPA/insurance company can revert with either of the following:
    • Initial Approval – The same will be alerted to you via a phone call.
    • Queries – Our team will get in touch with you to resolve the queries at the earliest. This will also be notified to you via a phone call.
During the Hospital Stay

During the hospital stay

  • If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the TPA helpdesk to the TPA / insurance company. However, if no enhancement is received from the TPA / insurance company, the patient will have to pay for the bill amount over and above the sanctioned amount.
  • If the TPA / Insurance Company intimates that the Sum insured is exhausted the patient needs to pay for the bill amount above the exhausted amount. The discharge process will however be as a TPA/ Insurance patient.
  • Receiving an authorization letter for Cashless hospitalization is only tentative. The TPA/Insurance Company can deny the claim for any reason during the course of treatment or after a patient is discharged. The 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 / Insurance Company.
  • At all stages the information will be shared with you via phone calls
Discharge Process

Discharge Process

  • On the day of discharge the patient’s final bill and discharge summary will be sent to the respective TPA / Insurance Company.
  • On receiving the final approval the patient’s discharge will be completed after taking the refundable deposit on sanctioned amount as a security deposit until the hospital receives complete payment from the TPA / insurance company
  • Patient is required to pay for all non-payable expenses as their policy does not cover the non-payable expenses
  • No original documents or reports of the hospitalization will be given to patient(except films), since these are to be sent by the hospital to TPA / insurance company along with the final bill for the final payment.
  • At the time of Discharge, the patient can collect a copy of final bill from the Billing department.
  • A photocopy of all the reports along with any pending reports can be collected from the Report Counter after 7 days of discharge.
  • After Final payment from the TPA / insurance company the patient will be intimated by phone call.
In case of denial

In case of Denial

On denial of Cashless hospitalization by the TPA / insurance Company the patient will be treated as a cash paying patient.

The TPA/ insurance company may not grant approval due to any of the following reasons:

  • If the ailment for which patient is hospitalized is not covered in their policy.
  • If the provided medical details of the patient is insufficient to approve the request, though most of the time the TPA / insurance company will request the hospital if additional information is needed.
  • If the patient has exhausted the sum assured for that year
  • In these cases the patient has to make the necessary payments as per hospital policy and go for reimbursement.

Frequently Visited

Get in touch

Breach Candy Hospital Trust, 60 A - Bhulabhai Desai Road Mumbai : 400026

   +91 - 22 - 23667788

   info@breachcandyhospital.org