Insurance & TPA
If you have any questions regarding your insurance, please call
K.J. Somaiya Superspeciality Centre provides the benefit of cashless hospitalization with a variety of insurance companies for the benefit of the patients. Please follow the process for cashless payments and pre-authorization with the hospital. We recommend, the patients' to check if their TPA/Insurance Company is covered and tied up with the hospital.
Important points to Note
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.
Empanelled lnsurance CO. & TPA's
EMPANELLED INSURANCE COMPANIES
EMPANELLED INSURANCE COMPANIES
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Bajaj Allianz
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Cholamandalam
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National Insurance
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ICICI Lombard
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Future Generali
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Reliance General
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Religare
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Royal Sundaram
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United India
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Star Health
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Oriental Insurance
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New India
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Apollo Munich
TPA's
TPA's
Alankit Health & Wealth
Anmol Medicare
Anyta Health
Bajaj Allianz
Dedicated Health Care
E-Meditek
Focus TPA
EwA
Genins India
Good Health
Happy TPA
Health India
cholomandalam
Vipul Medcorp
Md india
Medi Assist
Paramount LIC
Park Mediclaim
Raksha TPA
Rothshield
Sri Gokulam
Vidal Health Services
Medicare
Med Save
Family Health
Heritage Health
Process
The preauthorization forms of TPA tied up with the hospital can be collected from the TPA department of the hospital.
- Step 1: Patient presents for admission
- Step 2: Filling up of the Pre Authorization Form by treating doctor and sending to TPA/Insurance Company Concerned and waiting for initial approval. The estimated amount of expenditure is mentioned here.
- Step 3: TPA/ Insurance Company may revert back with queries if any which are replied by the hospital.
- Step 4: TPA/ Insurance Company sends provisional approval as per patient’s policy details.
- Step 5: Patient is allowed to undergo treatment at the hospital as per approval
- Step 6: Prior to discharge the final bill, treatment details & the discharge summary of the patient is sent to the TPA/Insurance Company for final approval.
- Step 7: TPA/Insurance Company may have multiple queries which have to be replied to by the hospital. Approval is not sent till all queries have be answered and the TPA/Insurance company is totally convinced that treatment has been done as per approval.
- Step 8: After final approval is received the patient is clear for discharge. This process takes atleast 4 - 6 hours depending on the TPA/ Insurance company.
How 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 and backside, the name of the TPA will be printed.
- Your insurance agent will be able to inform you accurately.
In Case of Denial
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.
Reimbursement Process
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 for reimbursement. If the Indoor case papers are required, kindly make an application in the TPA during working hours.
Disclaimer
K.J. Somaiya Superspeciality Centre reserves the right to deny the Cashless Facility to any of the Card Holders of Above Mentioned TPA’s. TPA 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 authorization would be of the patient / relative.
