TPA & Insurance Tie-ups

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TPA or Third Party Administrator is an organization that processes insurance claims provides service to a Mediclaim policyholder by providing Cashless Facility (depending on the case) for hospitalizations that come under the scope of his/her Mediclaim Policy.

Cashless hospitalization allows insured Patients to get admitted in Jeevan Rekha Hospital without paying money upfront. This means, the hospital bill of the insured person will be taken care of directly by the insurance company. The insured person will just have to pay the deductible amount and leave the rest to our expert insurance team.

In case of Planned Surgery Cases:

• Go to the TPA Desk on the 1st Floor Two days prior for a pre-authorization.
• Bring documents like - Corporate Employee card, TPA card of the patient, Patient’s Identity Card like Voter’s ID card, Aadhar Card, Pan Card, Driving License, Doctor’s prescription, and relevant supporting reports.
• Hospital will send the requisition to your TPA.
• Once the approval comes from your TPA you will be informed and you can get admitted for the surgery.

In case of Emergency Admission:

If you don’t have the documents mentioned above with you at the time of admission then you have to submit the documents within 24 hours of your admission at 1st Floor TPA Desk.

Non-Medical:

• Corporate Employee Identity Card of the employee
• Mediclaim Card of the patient
• Photo Identity Proof of the patient (Voter Card, Aadhar Card, PAN Card, Driving license, Etc.)

Medical:

• Previous Medical Documents (if any)
• Doctor’s Prescription
• Past Investigation 

Click on the link to find out : https://jeevanrekhahospital.com/insurance

• You do not have to worry about finances in case of a hospitalization, thus giving you peace of mind.
• Cashless claims facility has its advantages over the reimbursement model as it is quick and convenient.

At Jeevan Rekha Hospital, Specialist Doctors are available across various facilities who attends to patients immediately after Planned or Emergency admissions like Heart Attack, Brain stroke, Burns, Accidents etc.

Your room entitlement will be as per your policy in accordance with the decision of the Doctor. You can opt for a room in higher category subject to bearing the additional expenses. For example: If a patient opts for higher category bed, then any differential in expenses like room rent, doctor fees, investigation charges, procedure charges etc. arising due to a more expensive room will be borne by the patient.

In that case, the insured person will have to opt for the Reimbursement facility after settling all the Hospital Bills at the time of discharge by the patient.

Yes, a request for authorization for cash less access may be declined if,

• Inadequate/wrong information is provided and the TPA is unable to get access to additional information.
• The ailment/disease for which hospitalization/surgery is required is not covered by the insurance policy.
• The disease suffered for which hospitalization is claimed falls under policy exclusions clause.
• The person does not have adequate insured amount in the policy left to cover the hospitalization costs.

This only means that cashless access is declined, AND IS IN NO WAY TO BE CONSTRUED AS DENIAL OF TREATMENT. The policyholder must obtain the treatment as per his/her treating doctor’s advice & settle all the Hospital Bills at the time of discharge and then apply for reimbursement from the insurance company.

All bills in original and discharge certificate are to be left with the TPA Desk at Jeevan Rekha Hospital providing cashless treatment. The patient has to countersign all bills and fill the claim form and also leave the same with the hospital at the time of discharge.

A copy of the bills & Discharge Summary can be carried by you for your records.