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 Help Desk (Phone: 022-29673891/ Priya 8805489825) will assist you through the pre-authorization procedure.
In the 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.
However, the 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 Help Desk at the hospital
Step 2: At the 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 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 Help Desk in case of any difficulty)
Step 5: Return the completed form to the Help Desk. 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 Help Desk will fax the form to the office of your TPA.
Step 7: The Help Desk will revert to you on the approval/denial status
Step 8: At the time of admission, you shall be required to make a deposit payment of about Rs.10000/- which shall be refunded post discharge ,subject to completion of all formalities
