Government Scheme

• Employees State Insurance (ESI)
• Tamilnadu New Health Insurance Scheme
  • MD India Government Employee Scheme
  • MD India Pensioner Scheme
  • MD India Co-Operative Scheme
• Chief Minister Comprehensive Health Insurance Scheme

General Health Insurance

Cashless claims in our hospital (PSG Hospitals)

TPA(Names)

Procedure For Cashless Claims

A. Admission Procedures

To check the availability for cashless through ID Cards

The beneficiaries (patient) will be identified by the provider (hospital) on the basis of an ID card issued from TPA to all the beneficiaries.

The ID card shall have photograph and signature or thumb impression of the Patient.

Whenever there is a need for hospitalization the policyholder should bring their ID card and policy copy.

Insurance clerk will verify following details through ID card & policy copy

• TPA Name
• Corporate name
• Patients name and spelling
• Card validity period
• Age verification
• Photograph verification
• Pre existing coverage
• Sum-insured

To explain clearly about the terms & conditions for availing cashless facility to the patient.

B. Pre-Authorization

The terms & conditions for providing cashless facilities to the patient.

• When a doctor plans for admission , the insurance staff will verify the ID Card , Photo Id , Policy Copy and gets the concerned pre-authorization form filled up and signed with the seal of the doctor. The Patient / attender has to sign and enter the contact number in the pre-auth form. The same is sent to TPA / IC along with relevant investigations reports in case of planned admission. This can be done up to 7 days prior to expected date of admission.
• In case of emergency admission the pre-authorization form should be sent within 24 hours after admission . Any delay has to be communicated to TPA by insurance staff.
• The Pre authorization approval issued by the insurance company will have the following details like amount guaranteed , sub limits for room category, surgical fees etc, eligibility of beneficiary , validity Of the approval letter as per the benefit plan of the insured .
• The guarantee of payment is given only for the necessary treatment cost of the ailment covered and mentioned in the request for hospitalization. Any investigation or treatment carried out at the request of the patient apart from the authorization, those treatment charges will have to be born by the patient.
• When the cost of treatment exceeds the authorized limit an interim bill along with justification letter from treating doctor is sent for further enhancement of approval amount. At the time of discharge final approval should be obtained by sending the final bill, break up bill, discharge summary, pharmacy break up bills, any other information as required by TPA. On receipt of final approval the following procedures has to be followed before discharge of the patient.

C. Discharge Procedures

The final approval will have the final eligible amount and remarks on exclusions like non-medical expenses , co-payment and other disallowances the cost of which has to be born by the patient. Hence after collecting the same the patient can be discharged.

• If the enhancement amount is unauthorized, the balance amount should be collected from the patient.

If the total claim is denied the patient has to be treated as per hospital norms.