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Home»Guidebook for TPA Patients

Guidebook for TPA Patients

If you are the beneficiary of an insurance company, we will request you to please spare some time to understand the processing of insurance claims. Insurance companies have appointed TPA's (Third Party Administrator) to give you the facility of cashless claims. The claim is processed by the hospital which is further subjected to approval by your TPA.

"SBAMI Corporate desk" is only helping you to get your claim processed by TPA. In the event of the cashless authorization request being rejected by TPA, the patient has to pay the bill to the hospital and try to claim the expenses subsequently from the Insurance company or TPA.


What is Third Party Administrator (TPA)?


Third Party Administrators (TPA) is an important link between insurance companies, policy holders & healthcare providers (hospitals and nursing homes). A TPA's role is to provide administrative support to the insurance companies for servicing their insurance policies.

In order to avail cashless facility, you are requested to submit the following documents to the hospital based on which the corporate desk will process your case.

  •          TPA Card Copy / Policy Copy
  •          I.D. Proof
  •          In-door advise case paper
  •          Relevant diagnostic reports

 

 Please check the following details if you are Medically Insured:

 

  • Have you received the insurance cards from Third Party Administrator? If not, contact your agent or TPA.
  • If you have received the Insurance ID cards; check the name of the TPA before getting hospitalized.
  • If you have a fresh policy / first year policy or recently got your policy renewed; check with your TPA about your policy enrollment, failure of which can result in rejection of your cashless authorization request.
  • Medical insurance does not cover your OPD consultation/procedure/investigation done before being hospitalized.
  • All claims of the discharge from the hospitals will be processed by the TPA directly/or for reimbursements of all your post discharge expenses, directly file all originals documents, bill, prescription in TPA.
  • In case the authorized limit gets exhausted, get in touch with the "Shri Balaji Action Medical Institute Corporate desk".
  • At the time of discharge, the policy holder has to inform the "Shri Balaji Action Medical Institute Corporate desk" and is supposed to sign the claim form and a copy of the final bill.

 

Corporate Desk at Shri Balaji Action Medical Institute:


  • Shri Balaji Action Medical Institute Corporate Desk is in the atrium near main gate ground floor, which is open from – 8 AM to 7 PM everyday.
  • Only policy holders (those who have medical insurance) can avail the cashless service from TPA.
  • Shri Balaji Action Medical Institute Corporate Desk only helps the policy holders in getting cashless approval from TPA.
  • TPA will issue an authorization letter for the coverage as per the policy to Shri Balaji Action Medical Institute. The answer will come from TPA in the form of authorization letter.
  • Policy holders can directly approach the hospital's Admission Counter for admission with the ID card and one copy of the authorization letter will be given to the Admission/IP billing counter.
  • Hospital will extend cashless treatment to the policyholder up to the authorized amount.
  • At the time of discharge, the policyholder has to inform the "Shri Balaji Action Medical Institute Corporate desk" and is supposed to sign the claim form and a copy of final bill.

 

Do's and Dont's for availing cashless services from Third Party Administrators (TPA)

 

Do's

  • Obtain pre – authorization form from Shri Balaji Action Medical Institute Corporate desk 3 – 4 days prior to the admission for planned hospitalization.
  • Pre – authorization form is to be filled in by treating doctor.
  • Check about the pre – authorisation approval at the "Shri Balaji Action Medical Institute Corporate desk" within next 24hrs.
  • You can avail cashless treatment at the hospital after receipt of written authorisation from TPA for the covered ailment.
  • Leave back all the original documents and signed claim form with the hospital at the time of discharge.
  • Contact local TPA office in case of any query.
  • The policy holder has to bear the expense which is not covered under the terms and condition of the policy.

 

Dont's

  • Don't insist upon admission at the hospital merely for investigation, evaluation or health check – up as these are not approved by TPAs.
  • Don't insist on admission on cashless basis at the hospital without obtaining the pre-authorization approval from TPA.
  • Don't carry back any original documents at the time of discharge from the hospital, if your cashless is approved by the TPA.
  • Don't forget to sign the claim form.
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