Cashless hospitalization means as a policyholder, one will be able to avail medical services at designated hospitals and bills will be settled through TPAs (third party administrators) rather than direct out-of pocket-payment

Policies & Procedures

Yadgire SuperSpeciality Hospital is empanelled with most of the reputed insurance providers. We also accept employer covered insurance services Cashless facility is subject to the conditions and terms in the policy.

Insurance Providers

  • Reliance General Insurance Co. Ltd.
  • ICICI Lombard
  • HDFC Ergo General Insurance Co. Ltd
  • Bajaj Allianz General Insurance Co. Ltd.
  • Future Generali India Insurance Co. Ltd.
  • Maxbupa Health Insurance Co. Ltd.
  • IFFCO-TOKIYO General Insurance Company
  • Star Health & Allied Insurance Company

Empanelled TPAs

  • Genins India TPA Ltd.
  • Alankit TPA
  • Spurthi Meditech (TPA)
  • Vipul Medcorp
  • Dedicated Healthcare Services TPA Pvt. Ltd. (DHS)

Preadmission and Admission requirements:

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.

Your TPA may not grant approval due to any of the following reasons:

  • If the ailment for which you are hospitalized is not covered in your policy.
  • If the information contained in pre-authorization form is insufficient to approve the request, though most of the time the TPA will request the hospital if additional information is needed.
  • If you have exhausted the sum assured for that year.

The pre-authorization procedure is detailed below:

  • Establish contact with our Billing Department at the hospital
  • At the Billing Department, you need to present the original Health Insurance card issued to you by your TPA
  • Collect the pre-authorization forms pertaining to your TPA
  • Your pre-authorization form will have two sections-
  • General details on the health insurance policy - to be filled in by you
  • 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 Billing department in case of any difficulty)
  • Return the completed form to the Billing department. The personnel at the desk will verify the form for its completeness and let you know in case of any discrepancy
  • Once the form is complete in all respects, the Billing department will fax the form to the office of your TPA.
  • The Billing department will revert to you on the approval/denial status
  • At the time of admission, you shall be required to make a deposit payment of Rs. /- which shall be refunded post discharge ,subject to completion of all formalities

Getting Discharged

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.
You shall be required to

  • Settle the difference, if any, if your bill exceeds the designated insurance amount
  • Pay for all non-medical expenses as your policy will not cover them.
  • Check all the bills and prescriptions for any medicine that is billed but not administered to you.
  • Note the total amount of the bill for your records for future purpose
  • Submit all the medical documents including the lab reports, claim forms, discharge summary and final bill to the hospital before being discharged.
  • The hospital, then, submits all necessary documents to TPA. TPA processes the bill on the basis of eligibility and actual cost. TPA makes the claim payment to the hospital and / or patient (as per the policy terms and actual cost). You shall, then, be refunded the deposit amount of Rs. /- with deduction if any.

What if the cost for treatment exceeds the approved sum?

  • Generally the TPA only approves a part of the expenses of the treatment and only after the hospital sends the final bill along with the discharge summary and other reports does it approve the entire amount.
  • Sometimes the hospitals will request the TPA to increase the amount approved if needed during the treatment.