Routine Admission :
- When a routine hospitalization is required, the patient holding a mediclaim policy from any of the recognized companies is advised to contact the insurance cell.
- A pre-authorisation form will be issued which is to be filled and signed by both the patient and the treating Consultant. The patient is to produce the insurance policy (current and renewed) and ID card to the staff in the insurance cell. These will be faxed to the insurance / TPA office for approval. After receiving the authorisation the patient is to contact the treating Consultant for a date for admission.
Emergency admission :
- In the case of an emergency admission, the patient holding a mediclaim policy from any of the recognized companies can get admitted by producing the mediclaim ID card at the registration counter.
- Following admission they are advised to contact the insurance cell as early as possible and furnish the particulars required for obtaining sanction for cashless treatment.
- In cases where the patient requires an emergency procedure / investigation / treatment they are to deposit the required amount which will be later refunded once the sanction from the Insurance / TPA is received. The payment also can be made in the form of a guarantee cheque.
- During the course of hospitalisation if the patient requires any additional treatment / procedure apart from the one planned originally for which sanction was obtained, this is to be brought to the notice of the insurance cell.
- The Insurance / TPA will be informed and an application for an additional sanction will be made . In the event the additional sanction is not granted, the patient is to pay the amount out of pocket prior to discharge. If the recommended treatment is beyond the scope of GKNM Hospital, then the patient will be referred to a Centre where it is available and the bills will be included in the final bill.
- Patients are expected to give correct information about their present and past illnesses and complaints to fill the pre-authorisation form to be sent to the insurance / TPA. Information once submitted, will not be changed or altered for any reason. The same details will be given in the discharge papers also. Health information should not be concealed or altered while informing the treating Consultant, as this will affect the plan of treatment and also result in non sanction of claim.
- On discharge the patient is to pay all the expenses listed as “disallowable items” by the Insurance / TPA prior to settling the final bill. They are to collect a copy of the Discharge Summary and copies of all investigation reports from the Staff Nurse-Ward incharge before discharge.
- The original hospital bill, pharmacy bills , prescriptions, investigation reports, discharge summary will be retained by the Insurance Cell and sent to the Insurance / TPA for reimbursing the expenses incurred by the hospital.
- In the event the final bill amount exceeding the sanctioned amount, the patient has to wait till the insurance cell gets the additional sanction from the Insurance / TPA. In case of the re-sanction not materialising immediately, the patient has to stay back in the hospital till such time the additional claim is approved.
- In case the approval is received after working hours the patient has to wait till the next working day for discharge. Patients are requested to cooperate with the insurance cell to get clearance from the insurance / TPA. The patient has to pay charges for diseases for which no cover is provided by insurance companies / TPAs.
General information :
- Patients can inform about their mediclaim policy while registering in the out patient department itself. Brochures with full information about availing cashless insurance services are available at all registration counters and the insurance cell.
Keep your insurance active and do timely renewal.