To ensure smooth facilitation of cashless policy and documentation, the BM Birla Heart Research Centre has a dedicated Third-Party Administrator (TPA)/Insurance help desk. A list of empanelled TPA/insurance companies is listed for reference.
Guidelines for Seamless Qualification of Health Insurance Policies
Essential Documentation Required for Cashless Services
- Cashless card from TPA
- Photocopy of ID card
- Photocopy of current insurance policy
To avail in-patient hospitalisation services, follow the procedure stated below:
For Planned Hospitalisation
- Contact the Insurance Helpdesk with the mentioned documents, along with the doctor’s admission advice, at least 3 days prior to the admission for necessary formalities
- Authorisation for cashless service from patient’s TPA
For Emergency Hospitalisation
- Admit the patient
- Contact the Insurance Helpdesk with the essential documents as early as possible for necessary formalities
- If authorisation for ‘Cashless Service’ from TPA is received, one can avail cashless facility thereafter for treatment in the hospital, up to the amount sanctioned by the TPA
Please fill the declaration form related to patients with mediclaim policies at the time of admission. Do try and ensure accuracy in information to help us serve you better.
Payment for Non-Authorised Items
If authorisation for cashless service from the TPA has been received at the time of discharge, the patient needs to pay for the following:
- Items that are not reimbursable under the mediclaim policy
- Hospitalisation expenses in excess of the insured amount
Denial of Cashless Service
In case of denial of cashless service by the TPA, the patient is requested to settle hospital bills themselves. BMBHRC will then supply all bills and reports to enable the patient to lodge their claim for processing and reimbursement directly with the TPA.
Being a referral & model hospital for many organizations, the centre has agreements with many PSUs, state government and private companies. For guidance for admissions and other processes, please contact the corporate. Our team of executives stand ready to assist you.
TPA Company and Contact Details
|No.||Company||Contact Nos.||Fax Nos.|
|1||ICICI Lombard||JAYDEEP BHATTACHARYA
|1800 209 8880
+91 40 firstname.lastname@example.org
|2||Paramount||MR. SUBHRAJIT BHADURI –
|+91 33 23567014
|3||TTK/VIDAL HEALTH||PARAMITA MISTRI
+91 33 22884198
|+91 33 22884194|
|6||MEDSAVE||MR. ANUP AGARWAL
+91 9830154185PREETI TALWAR/ARPITA
|+91 33 22299282
|7||MEDI ASSIST||MRS. SMITA PAUL
|+91 33 39835702
+91 22 66376933
MR. TARAK+91 8798085986
|+91 20 25300003
|9||Bajaj-Alliance||MR. DEEP NARAYAN MUKHERJEE
|+91 20 30512224/7
|10||Alankit||+91 11 42541234
+91 22 40581251/52
|+91 11 42541276/67
|11||Raksha TPA Pvt Ltd.||MR. PRASANTA GHOSH
|+91 129 4289999
+91 22 67876624
|12||Vipul Med Corp.||+91 124 4699611/12/13
MR. RAJEEV OJHA
+91 33 40205711MR. ABU SALIM
|+91 33 40205712
+91 124 4308211/2
|13||Dedicated Healthcare Services||MR. RATAN DAS –
email@example.comMR. UJJWAL GHOSH
|14||EMEDITEK||MS. PIYALI BASU
|+91 124 4466677
Given below are a few frequently used terms pertaining to medical insurance that you need to be familiar with.
A special benefit extended by an insurer or by the assigned TPA for availing medical treatment as an inpatient without the necessicity to pay the treatment costs up front to the hospital. Under this procedure, the payment due to the hospital will be met out either by the insurer or by the assigned TPA. After the discharge from the hospital the bills pertaining to medical expenses incurred at the hospital, are sent to the Insurer/TPA, (subject to insurance policy and conditions) for reimbursement by the hospital. The hospital can claim in accordance to the pre authorised limit and additional cost as envisaged by the enhancement. In any case the upper limit of this facility cannot exceed the sum insured under the contract of insurance.
Repudiation of a Pre authorisation request /Admission liability/Cashless facility and or settlement of a claim under the insurance contract.
Any difference between the amount claimed and admissible amount and also any violation of terms & conditions of the insurance policy or agreement.
Medical treatment for period exceeding 3 days for such illness/diseases/injury, which in the normal course would require care and treatment at a hospital but is actually taken whilst confined at home under certain circumstances (where the patient cannot be moved to the hospital or due to lack of accommodation – as per the definition of insurance policy).
A situation when insurer seeks to increase the limit of the authorized claim amount resulting from extension of hospitalisation.
The items that are specifically and expressly removed from the scope of the insurance contract and hence are not payable.
Medical treatment after getting admitted in a hospital.
The maximum limit up to which the insured can seek medical treatment under that mediclaim policy.
Individual, who by paying a premium, secures himself to receive medical treatment up to a fixed sum of money in the event of injury, loss or damage to his body.
A corporate body licensed by IRDA for underwriting various insurable risks against any or all insurable perils with an assurance to make good the loss in an unforeseen eventuality.
Insurance Regulatory & Development Authority, a body constituted under the Ministry of Finance to deal with licensing, regulating and monitoring all activities relating to the insurers, brokers, agents, corporate agents and the TPA’s.
Restrictions in the operative clause of the insurance contract to the limit of benefits, use etc.
A card issued by your TPA with a primary purpose of identification. This contains the policy number, name and validity period. Many of the TPA’s prefer to place insured’s photograph & signature to improve its authenticity. Though it is being popularised as a cashless card, it serves only as a means to avail cashless benefit subject to the terms & conditions of the policy.
An insurance policy that covers hospitalisation expenses incurred during an inpatient hospitalisation. Please check terms and conditions of the policy to understand the nature and the scope of risk covered.
Medico Legal Case
A situation arising out of treatment at the hospital for any bodily injuries sustained in an accident or an attempt of suicide, which needs to be intimated to the police and other concerned authorities for any investigation and procedures. For example burns, suicide, Road Traffic Accident, assault, etc.
A hospital which has entered into an agreement/MOU with an insurer or a TPA to request pre authorisation, extend cashless facility and accept payment at a later date on submission of bill complying to the policy requirements. Those hospitals who do not have a prior agreement for cashless hospitalisation with your insurer/TPA are called non-network hospitals.
Taking advantage of the medical condition where one does not require immediate hospitalisation (as it would not affect his quality of life in any way), the insured seeks pre authorisation sufficiently in advance of actual admission in the hospital for treatment on cashless basis.
Policy Terms & Conditions
Terms and conditions outlining the details and the limitations of the insurance contract indicating the requirements for fulfilling or adhering to the contract of the insurance.
Authorisation issued by the insurer or by the assigned TPA for admission and treatment up to a value as deemed fit by the insurer, for treatment by the hospital. To receive pre authorisation one has to make a request providing the details contained in the Pre Authorisation Form.
Clarification requested to dispel any doubt pertaining to the line of treatment and the contract of insurance.
A facility under which the insured can claim the expenses borne by him during hospitalisation which is otherwise claimable under his insurance contract.
Toll Free Number
A telephone number (calls to which are not charged) provided by your insurer/TPA to get in touch with them for any clarification.
A corporate body licensed by IRDA for processing and setting on their behalf, claims arising under medical insurance policies and to coordinate with hospitals for all relevant and related processes.