Insurance & TPA
Nirali Cancer Hospital provides cashless medical insurance (Mediclaim) services for patients having a health insurance (Mediclaim) policy from the empanelled private insurance companies and third-party administrators (TPAs).
When routine hospitalisation is required, the patient holding a Mediclaim policy from any of the recognised companies is advised to contact the insurance cell.
A pre-authorization form will be issued. This has to be filled in and signed by both the patient and the treating consultant. The patient is required to furnish the insurance policy (current and renewed) and ID card and present them to the staff in the insurance cell. These will be submitted to the insurance/TPA office for approval. After receiving the authorisation, the patient has to contact the Treating Consultant for a date for admission.
In the case of an emergency admission, the patient holding a Mediclaim policy from any of the recognised companies can get admitted by producing the Mediclaim ID card at the registration counter.
Following admission, they are advised to contact the insurance cell as early as possible and furnish the particulars required for obtaining sanction for cashless treatment.
In cases an emergency procedure/investigation/treatment is needed, patients are required to deposit the requisite amount at the Hospital. This which will be refunded once the sanction from the Insurance/TPA is received. Payment can also be made in the form of a guaranteed cheque.
During the course of hospitalisation, it is possible that the patient may require additional treatment/procedure apart from the one planned originally and for which sanction was obtained. Such cases have to be brought to the notice of the insurance cell.
The Insurance/TPA will be informed and an application for an additional sanction will be made. In the event the additional sanction is not granted, the patient is responsible for paying the amount out of pocket prior to discharge. If the recommended treatment is beyond the scope of Hospital, then the patient will be referred to a Centre where such treatment is available. All bills will be included in the final bill.
Patients are expected to furnish correct information about their present and past illnesses and complaints and fill the pre-authorisation form to be sent to the insurance/TPA. Information once submitted, will not be changed, or altered for any reason. The same details will be indicated in the discharge papers. Health information should not be concealed or altered while informing the Treating Consultant, as this will affect the plan of treatment and result in non-sanction of claim.
On discharge the patient is required to pay all the expenses listed as Non-medicals/Non-payables/’Disallowable items’ by the Insurance/TPA prior to settling the final bill. They should collect a copy of the Discharge Summary and copies of all investigation reports from the Staff Nurse, Ward In-charge before discharge.
The original hospital bill, pharmacy bills, prescriptions, investigation reports and discharge summary will be retained by the Insurance Cell and sent to the Insurance/TPA for reimbursing the expenses incurred by the hospital.
At the time of discharge, the patient has to wait till the insurance cell receives final sanction from the Insurance/TPA. In case of the re-sanction not materialising immediately, the patient has to stay back in the hospital till such time as the additional claim is approved.
In case the approval is received after working hours the patient has to wait till the next working day for discharge. Patients are requested to cooperate with the insurance cell to get clearance from the insurance/TPA. The patient has to pay charges for diseases for which no cover is provided by insurance companies/TPAs.
AYUSHMAN BHARAT- PM-JAY
Nirali Cancer Hospital is recognised under the Pradhan Mantri’s Comprehensive Health Insurance Scheme (PMJAY) to provide treatment (outpatient and inpatient care) in the following specialties:
This scheme is applicable to the PM-JAY card holders. The following documents (originals) are to be produced by the individuals who wish to avail of the scheme.
For further information regarding the PM-JAY scheme in the Nirali Cancer Hospital, kindly contact the Liaison officer/staff in PM-JAY Pradhan Mantri’s Comprehensive Health Insurance Scheme (PMJAY) help desk located in the ground floor of the Nirali Cancer Hospital .