MEDICLAIM INFORMATION:

IN THIS patient pays all the payments to hospital as per bills and will claim to company directly and money comes in their accounts directly . Our staff will be happy to assist you to make the file ready for mediclaim as per your agent requirements provided it has been informed at the time of admission.

CASHLESS INFORMATION:

  • Kapadia Multispeciality Hospital is one of the leading hospitals in Mumbai for personalized care and for cashless.
  • Kindly confirm with your policy copy or agent as to which TPA would be processing your cashless.

LIST OF TPA’S: As Per Dated July 2015

PLEASE NOTE THIS LIST NEED TO BE VERIFIED BY PATIENT BEFORE ADMISSION

  • M D India Corporate
  • Religare
  • Reliance General
  • Max Bupa
  • DHS
  • HDFC Ergo
  • IFFCO TOKIO
  • Shipping corporation
  • Medi Assist (Corporate Tech Mahindra)

Hospitalization Benefits for TPA Patients:

Patients can avail the benefit of cashless hospitalization at our hospital if the TPA is tied up with the hospital.

How to Identify Your TPA & whether it is on panel with Kapadia Hospital?

  • The TPA will issue you an identity card which will indicate the name of your TPA.
  • On your insurance policy, on the lower left hand corner of the policy, the name of the TPA will be printed.
  • Call up toll free number mentioned on policy card to find out whether you can opt for cashless in our hospital.

Rules and regulations And Documents for Cashless

Please Note:

  • CASHLESS SERVICES ARE PROVIDED FROM 9:00AM TO 8:00PM. They are not provided during Sundays and Bank Holidays.
  • VALIDITY OF HOSPITAL ON PANEL OF YOUR TPA IS SOLE RESPONSIBILITY OF PATIENT OR RELATIVE.
  • Possessing a TPA card does not entitle the patient to get cashless benefit. A certain defined procedure for obtaining sanction from the TPA has to be followed.

ADMISSION PROCESS:

  • INFORMATION: In case of unplanned/emergency hospitalization patient or relative should inform at the time of admission or maximum within two hours of admission.
  • Planned admission on opd basis— cashless approval should be obtained from the TPA at least 5 days prior to the date of admission.
  • DOCUMENTS: Documents providing is the sole responsibility of relative maximum within 2hours. The name and address of the patient should be mentioned properly without spelling mistake and needs to be checked by the relative on each document given. CHECKLIST FOR TPA DOCUMENTS:
    • Policy Paper
    • Policy ID
    • Photo ID
    • OPD consultation paper stating hospitalization, diagnosis, duration of illness, any past history if mentioned.
    • Investigation reports.
  • DEPOSIT FOR OPD SANCTION—Rs. 2000 to be paid for cashless approval formality with the submission of papers which will be refundable on discharge or get adjusted with the funal bill on discharge as per the term.
  • DEPOSIT: At the time of admission, even if the TPA has approved cashless, a refundable security deposit of minimum Rs.5000-Rs.30,000 as per class of room and with terms and conditions has to be paid by the patient /relative.
  • ROOM CATEGORY: Selection of room as per policy is solely the patient or relative responsibility.
  • REFUND :
    • Statutory deposit of Rs.5000/- to Rs.30,000/- will be refunded after 45-60days by cheque payment, PROVIDED WE HAVE RECEIVED FROM THE COMPANY ,deducting the non payment done by company.
    • Additional deposit if any paid during admission and final bill sanctioned full then keeping statutory deposit rest balance money will be refunded after two days by cheque payment.
    • Patient cannot leave hospital before final sanction is received by the hospital.
  • DURING HOSPITALISATION:
    • MEDICAL HISTORY: The patient must give a proper and true medical history to the doctor at the time of filling in the pre-authorization form, since any discrepancy may result in the denial of the claim and cancellation of the approval.
  • PAYMENTS:
    • All the payments of investigations, medicines, hospital services, doctors and any other should be paid in addition to the deposit till the sanction from TPA comes.
    • If sanctioned amount is less than the estimated bill any time during admission, patient or relative need to settle from time to time.
    • Whatever services not sanctioned by TPA has to be paid by patient or relative before discharge.
  • DISCHARGE PROCESS:
    • Patient cannot be discharged unless full and final settlement of bill is done either by TPA or relative of patient.
    • Balance, non sanctioned amount has to be settled and documents to be signed before discharge.
    • The hospital will retain minimum Rs.5000/- to maximum Rs.15,000/-amount as refundable deposit till the hospital receives complete payment from TPA. On settlement of payment from TPA the patient will be intimated by phone call TO RECEIVE THE BALANCE REFUND
    • No original hospital documents or reports will be given to patient , since these are sent by the hospital to TPA along with the bill for reimbursement. Xerox copies of the same can be taken by the relative at his own cost.
    • The patient if need be can collect a copy of final bill from accounts department.
    • Any pending reports or films should be collected from the hospital within 10 days of discharge.
  • DENIAL PROCESS:
    • Hospital is not responsible for any cancellation of cashless by TPA.
    • On denial of cashless hospitalization by the TPA, the patient will be treated as cash paying patient & will have to make the necessary payment as per hospital policy.