INSURANCE & TPA’S

INSURANCE & TPA’s

MEDICAL INSURANCE DEPARTMENT AT DR.MUTHUS HOSPITALS CASHLESS HOSPITALIZATION

A Third Party Administrator (TPA) is an important link between insurance companies, Policy holders & healthcare providers(hospitals). TPA’s role is to provide administrative support to the insurance companies for servicing their insurance policies. However, it is important to understand the role of a hospital in cashless hospitalization.

The hospital is only a facilitator and has no authority to approve/disapprove any request for cashless hospitalization. Protocols laid down by the Insurance Regulatory and Development Authority(IRDA) with respect to cashless hospitalization will need to be adhered to strictly. You are the beneficiary of the insurance company and we request you to spare some time to understand the processing of insurance claims.

Insurance companies have appointed TPA’s(Third Party Administrators) to give you the facility of cashless hospitalization. The claim is processed by the hospital subject to approval by your TPA. “Dr.Muthus Hospitals Insurance Claims Department” is only helping you to get your claim processed by TPA. In the event of the cashless authorization request being rejected by TPA, the patient has to pay the bill to the hospital, and try to reimburse the expenses subsequently from the Insurance company or TPA

Emergency Admissions

For cashless treatment, it is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval, or when you cannot wait for receiving the approval owing to medical urgency, you can undertake the treatment by paying the necessary cash deposit. In case of emergency hospitalization, the Insurance Help Desk will take up your case on a fast track basis with your TPA, and is likely to receive approvals within 3-4 hours during any working day. If you receive an approval from your TPA after paying the cash deposit, you are entitled for refund of the cash deposit by cheque, within 2-3 working days after discharge.

Planned Admissions

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 an approval of the estimated hospital expenses with your TPA at the date of hospitalization. Our Dr.Muthus Hospitals Claims Department will assist you with the pre-authorization procedure. However, you will need to bear in mind that we are only a facilitator and can in no way influence the decision of the approval. Approval/denial of cashless facility is the decision of the TPA, which depends on your policy terms & conditions.