MEDICLAIM AND CORPORATE SERVICE

SAHAJ Hospital is  honored to be in the list of Hospital Service Provider with following top – notch & leading TPA/HEALTH INSURANCE COMPANIES :

 Insurance Company ( GOVT) :- 

  • New India Assurance Co.Ltd.
  • Oriental Insurance Co.Ltd.
  • National Insurance Co.Ltd.
  • United India Insurance Co.Ltd.

TPA’s and Pvt.  Insurance Company 

  1. ALANKIT HEALTH CARE TPA LTD.
  2. APPOLLO MUNICH HEALTH INSURANCE CO. LTD.
  3. BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD.
  4. CHOLAMANDALAM MS GENERAL INSURANCE CO. LTD.
  5. E-MEDITEK SOLUTION TPA LTD. & MEDICASH SCHEME
  6. ERICSON TPA HEALTH CARE PVT. LTD.
  7. FHPL (Family Health Plan Ltd)
  8. FUTURE GENERALI INDIA INSURANCE CO. LTD.
  9. FOCUS HEALTH CARE LTD.
  10. HDFC ERGO GENERAL INSURANCE CO. LTD
  11. IFFCO TOKIO GENERAL INSURANCE CO. LTD.
  12. INDIA HEALTH CARE 
  13. MAX BUPA HEALTH INSURANCE COMPANY CO. LTD.
  14. MEDI ASSIST INDIA TPA PVT. LTD.
  15. MEDICARE TPA SERVICES PVT LTD
  16. MEDSAVE HEALTH CARE TPA LTD.
  17. PARAMOUNT HEALTH SERVICES PVT LTD
  18. RAKSHA TPA PVT. LTD.
  19. RELIANCE GEN. INSURANCE CO. LTD.
  20. RELIGARE HEALTH INSURANCE Co. LTD.
  21. ROYAL SUNDARAM LIFE INSURANCE CO. LTD.
  22. STAR HEALTH AND ALLIED INSURANCE CO. LTD.
  23. SPURTHI MEDITECH (TPA) SOLUTIONS PVT. LTD.
  24. TTK HEALTHCARE SERVICES PVT LTD.
  25. VIPUL MEDCORP TPA PVT LTD.
  26. DEDICATED HEALTHCARE SERVICES (INDIA) PVT. LTD).
  27. VIDAL TPA PVT LTD
  28. UNITED HEALTH CARE LTD.
  29. PARK TPA . 
  30. TATA AIG INSURANCE CO. LTD 
  31. SBI GENERAL INSURANCE 
  32. VIDEOCON GENERAL INSURANCE 
 Corporates
  • Avtec Pvt Ltd
  • Bharti Airtel
  • Bank Of India
  • Bridgestone India Ltd.
  • Eicher (VE Commercial)
  • IIM
  • IIT Indore
  • Pratibha Syntex  Ltd.
  • Radisson Hotel
  • SBI General Insurance
  • Sayaji Hotels Ltd.
  • TATA Motor
  • Grassim Nagda
  • Liu- gong
  • Dainik Bhaskar
  • Nahata Professional Academy.
  • IDEA cellular
  • Airtell

(Sahaj Hospitals Indore Reserves the right to deny the Cashless Facility to any of the Card Holders of Above Mentioned TPA’s.)

Hospitalization benefit for TPA Patients

Patients can avail the benefit of Cashless hospitalization at Sahaj Hospitals Indore if the TPA that the patient is covered by is tied up with the hospital.

How to identify your TPA?

There are several ways to identify your TPA:

  • 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.
  • Your insurance agent will be able to inform you accurately.

Where to get TPA Pre authorization forms?

The pre authorization forms of TPA tied up with the hospital can be collected from the marketing/administration department.

Important points to Note:

Possessing a TPA identity card does not automatically entitle the patient to get Cashless benefit. A certain defined procedure for obtaining sanction from the TPA has to be followed.

Admission process:

  • For all elective / planned admissions, Cashless approval should be obtained from the TPA atleast 2 days prior to the date of admission.
  • Marketing department will assist you in faxing the duly filled pre authorization form of the TPA (along with the latest policy copy and positive investigation reports.)
  • At the time of admission, even if the TPA has approved cashless, a refundable security deposit of Rs. 5000/- is to be paid by the patient.
  • Incase the bed class / room specified in the authorization letter is not available, the patient will be admitted in the higher or lower class as per choice of patient. In case of admission in the higher class, patient will have to pay the difference in the charges from the date of admission.

During hospitalization:

  • 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.
  • In case the patient is transferred to ICU/ICCU/ Recovery room and wants to retain the original bed then patient will have to keep an additional security deposit, depending on the class and number of days in ICU/ICCU/Recovery Room, as the TPA does not pay for dual occupancy.
  • Receiving an authorization letter for Cashless benefit is only tentative. If the claim is denied for any reason by the insurance company during the course of treatment or after patient is discharged, 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.
  • If the patient bill exceeds the sanctioned amount, an estimate for the additional amount will be sent through the marketing department to the TPA. However, it is primarily the responsibility of the patient / relative to keep track of the bill. If no enhancement is received from the TPA, the patient will have to pay for the bill amount over and above the sanctioned amount by the TPA.

Discharge process:

  • The hospital will retain Rs. 5000/- refundable deposit for every one lakh of the sanctioned amount as deposit until the hospital receives complete payment from the TPA. On settlement of payment from the TPA, the patient will be intimated by SMS regarding procedure of refund of deposit.
  • The hospital shall collect payment for all exclusions / non-medical expenses / surcharge, if they are not covered by TPA at the time of discharge.
  • No original hospital document’s 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.
  • At the time of Discharge, the patient can collect a copy of detailed bill / summary from the accounts department.
  • Any pending reports or films should be collected from the mediclaim department within 10 days of discharge.

Denial process:

On denial of Cashless hospitalization by the TPA, the patient will be treated as a cash paying patient and will have to make the necessary payments as per hospital policy.

For Reimbursement:

For patients who do not avail the benefit of Cashless hospitalization or whose claims are denied for Cashless, please contact your respective TPA along with patient’s Discharge card, all Original reports, claim form of insurance company and hospital bills (to be attested by Medical Superintendent. / Officer on Special Duty) for reimbursement. If the Indoor case papers are required, kindly make an application in the Medical Superintendent . Office / OSD Office during working hours.

Sajaj Hospitals Indore Reserves the right to deny the Cashless Facility to any of the Card Holders of Above Mentioned TPA’s.
Mediclaim department will assist you and guide you in the process of obtaining the cashless facility from the TPA / Insurance company.

However the primary responsibility of obtaining the authorisation would be of the patient / relative.

MEDICLIM  DEPARTMENT
Sahaj Hospitals, 15/2, South Tukoganj, Indore, M.P.

Mobile no: 8223082666
Telephone No.: 0731-2510 200

Website:www.sahajhospitals.com
Email : mediclaim@sahajhospitals.com