Frequently Asked Questions

First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf. Cashless hospitalization is a facility provided by most health insurance policies and enables an insured customer to obtain admission and undergo the required treatment without direct payment. The assigned TPA will mediate between the healthcare service provider (hospital) and the insurance company and settle the bills on behalf of the insured customer.

However, it is important to understand the role of a hospital in cashless hospitalization. The hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization. Certain protocols laid down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization will need to be adhered to strictly.

What procedures should I follow to avail the facility of cashless hospitalization at Pragna Hospitals? Hospitalization happens under two circumstances – planned and emergency. Pre-authorization of the estimated hospital expense is a must to avail this facility.

Planned Hospitalization: In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must apply for approval of the estimated hospital expenses directly by your TPA at least 4-5 days prior to the date of hospitalization.

In case you have not applied for pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Corporate Help Desk will assist you through the pre-authorization procedure. However, you will need to bear in mind that the Corporate Help Desk is only a facilitator and can in no way influence the decision on the approval. Your TPA may not grant approval.

The pre-authorization procedure is detailed below:
Step1: Establish contact with the Corporate Help Desk at the hospital
Step2: At the Corporate Help Desk, you need to present the original Health Insurance card issued to you by your TPA
Step3: Collect the pre-authorization forms pertaining to your TPA
Step4: Your pre-authorization will have two sections-

General details on the health insurance policy – to be filled in by you (the Corporate Desk will assist you in case you have any difficulty)

The treatment recommended for you-to be filled in and duly signed by the doctor who is treating you (Do not attempt to fill this section, contact the Corporate Desk in case of any difficulty)

Step 5: Return the completed form to the Corporate Help Desk. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy
Step 6: Once the form is complete in all respects, the Corporate Help Desk will fax the form to the office of your TPA.
Step 7: The Corporate Help Desk will revert to you on the approval/denial status

Emergency Hospitalization: In case of emergency hospitalization, the Corporate Help Desk will take up your case on a fast track basis with your TPA and is likely to receive approvals within 6 hours during any working day.

For cashless treatment it is mandatory for the hospital to have an approval from your TPA. In case of delay in receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can undergo the treatment by paying the necessary cash deposit. If you receive approval from your TPA, you are entitled for refund of the cash deposit.

Cashless hospitalization is linked to the approval of the estimated expenditure on your proposed treatment. In case you do not get your approval you will need to bear the entire expenditure incurred on the treatment. Therefore it is always prudent to get approval and then get yourself admitted. You could explain to your doctor the benefits of getting approval before the date of admission as also when he recommends immediate admission.

Pragna Children’s Hospitals and Perinatal Centre will not entertain any request for a refund of the amount paid if the approval comes after the process for your discharge has commenced.

All the original documents including bills, lab reports, discharge summary and claim form. All the original documents duly signed by you need to be submitted to the hospital.

Normally your request for approval might be rejected when:
Information contained in the pre-authorization form is insufficient for the TPA to arrive at a decision and further information is not available for various reasons. However the chances of rejection under this criterion are rare since the Corporate Help Desk at the hospital is experienced in complying with pre-authorization formalities and will advise you suitably.

The ailment for which hospitalization is being sought by you is not covered under your insurance policy for reasons like pre-existing ailment, specific exclusions (accident admission under the influence of alcohol).

You have exhausted your eligible medical insurance cover for the year.

In case your hospitalization expenses exceed the pre-approved amount, you can approach the Corporate Help Desk to apply for an enhancement of the pre-approved amount.

The Corporate Help Desk will apply for an enhancement on your behalf with the TPA and provide the necessary documentation. In case you have not exhausted your medical insurance limit, it is most likely that your TPA will approve the application for the enhancement, either for the requested enhanced amount or up to your insured limit after deducting the value already utilized by you during the year, whichever is less.

If the TPA turns down the request for enhancement you will need to pay the amount incurred in excess of your approved amount directly to the hospital before discharge.

For complete details on the medical expenses that are covered, and those that are not covered, you need to go through your health insurance policy. However, in general, the expenses listed below are not reimbursable under cashless hospitalization
Registration / Admission fee
Telephone charges
Visitor / Attender charges
Ambulance charges
Charges for diet, which is not part of the administered treatment
Document charges
Toiletries
Non-medical expenses
Service charges
Room charges not eligible for
These need to be paid by you directly to the hospital at the time of discharge.

Pragna Children’s Hospitals and Perinatal center has a tie-up with several TPA’s. (Current list is given below). How ever this is dynamic and will change from time to time. Kindly contact the Corporate Help Desk for an updated list.

BAJAJ ALLIANZ GENERAL INSURANCE CO. LTD.
GE Plaza, Airport Road, Yerawada,
Pune-411 006.
Head Office Tel : 020-30305858, 020-5602 6666
Head Office Fax : 020-5602 6667, 5602 6678
Website : www.bajajallianz.co.in

E-MEDITEK SOLUTIONS LIMITED
No.45, Nathupur Road, Gurgaon-122 022.
Head Office Tel : 0124-5062068, 5062070
Head Office Fax : 0124-5062071
Website: www.emeditek.com

FAMILY HEALTH PLAN LIMITED
No.55, Ali Towers (2nd floor),
Greams Road, Chennai – 600 006.
Toll Free No : 1600 425 4033
Local Tel : 044-28293222, 28293777
Local Fax : 044-28292339
Head Office Tel : 040-23551717
Head Office Fax : 040-23556161, 23556262
Website : www.fhpl.net

MEDI ASSIST INDIA PVT. LTD.
Flat No.5, 1st Floor, B.R.Complex, 33,
C.P.Ramaswamy Road,
Alwarpet, Chennai –600 018.
Toll Free No : 1600 425 9449
Local Tel : 09444032085
Local Fax : 16004259559
Head Office Tel : 080-26538790/91/92
Head Office Fax : 080-26539563/8793
Website : www.mediassistindia.com

MEDICARE TPA SERVICES INDIA PVT. LTD.
No.1, Circular Road, united India Colony,
Kodambakkam (opp. Meenakshi College),
Chennai – 600 024.
Chennai Help Line : 9841030842
Local Tel : 044-24721857
Local Fax : 044-24721856
Website : www.medicareservicesindia.com

PARAMOUNT HEALTH SERVICES PVT. LTD.
No. 749, 3rd Floor, Anna Salai,
Chennai – 600 002.
Local Tel : 044-28586490
Local Fax : 044-28586852
Website : www.phmhealth.com

TTK HEALTH CARE SERVICES PVT. LTD.
No.749, 3rd Floor, Anna Salai,
T-Nagar, Chennai-600 017.
Toll Free No : 1600 425 8885
Toll Free No : 1600 425 2626
Local Tel : 044-52054340/4341/4342
Local Fax : 044-52024343, 52183300
Head Office (Bangalore): 80-25204027 / 51155030/31
Head Office Fax : 080-25204296 / 51255797
Website: www.ttkhealthcareservices.com

UNITED HEALTHCARE INDIA PVT. LTD.
AD-1, 2nd Floor, Radhakrishna Complex,
2nd Avenue, Anna Nagar,
Chennai – 600 040.
Toll Free No : 1600 22 4646, 1600 22 4545
Local Tel : 044-26190101, 26190102
Local Fax : 16004259559
Head Office Fax : 022-24914646
Website : www.uhcindia.com

GOOD HEALTH PLAN LTD.
S.V.R Towers, 4th Floor, Sinagar Colony Road,
Punjagutta, Hyderabad 500 082.
Local Tel : 040-66825003, 23735006
Local Fax : 040-66828081
Website: www.ghpltpa.com