If you have a planned hospital admission, consult your doctor to get an estimated date for hospitalization. You should then apply for approval of the estimated hospital expenses through your TPA at least 4-5 days before the admission date.

If you couldn’t apply for pre-authorization in advance, or if your doctor advises immediate hospitalization, our TPA Help Desk can help you with the pre-authorization process. You can reach them at tpa@jinkushalcardiaccare.com or 8850264251 between (8:00 am to 8:00 pm), Monday to Saturday, and from 9:00 am to 5:00 pm on Sundays and hospital holidays.

Do I Need To Carry Any Documents To The Hospital If I Want It To Be Cashless?

Yes, documents you should carry to the hospital in case of a cashless mediclaim policy: 

1. Identification proof: A photo ID such as a Aadhar Card, Pancard that confirms your address, and date of birth 
2. Health insurance card: Provided by the insurer 
3. Doctor’s prescription: For hospitalization, medicines, diagnostic tests, or consultation letter issued by the doctor 
4. Medical reports: Such as diagnosis reports, blood test reports, and x-rays 
5. Discharge card or summary in case of any recent admission or transfer from other hospital, it Provides us information about the patient, the cause of hospitalization, and proof of release and also the final approval letter from previous hospital in case cashless facility was availed.

Please note that the Help Desk only facilitates the process and cannot influence the TPA’s decision. Your TPA may deny approval if:

1. The ailment is not covered by your policy.
2. The pre-authorization form lacks sufficient information.
3. You have exhausted your sum assured for the year.

Pre-Authorization Procedure

1. Contact the TPA Help Desk at the hospital or check the provided information for cashless processing or reimbursement details.
2. Collect Forms: Obtain the pre-authorization forms, TPA Checklist, and TPA Undertaking form from the OPD Customer Care desk or download them. Show your Health Insurance card for assistance.
3. Fill Forms: Complete the pre-authorization form.

• Section 1: General insurance details (you fill this out; the TPA Help Desk can assist).
• Section 2: Treatment details (filled and signed by your doctor). The TPA Checklist and Undertaking forms are self-explanatory.

4. Submit Documents: Return the filled forms and required documents to the TPA Help Desk, or email a single PDF file of all documents to tpa@jinkushalcardiaccare.com with the subject “Patient’s name, HH Number, and mobile number.” The desk staff will verify everything.
5. Processing: The TPA Help Desk will upload and send your documents to your TPA.
6. Approval Status: You will be informed of the approval or denial status via your registered mobile number, or you can collect information from our TPA Help Desk

For more information, contact Jinkushal Cardiac Care & Superspeciality Hospital customer care between (8:00 am to 8:00 pm).

Do I Need To Pay Anything If I Have Applied For A Cashless Facility & Received Pre-Authorization Or Approval From My Insurance Company?

YES, you may have to pay extra depending on the following conditions as per the TPA/insurance Company.

1. Amount exceeding sum insured: If your bill is higher than the total sum insured as per your policy, the difference is to be paid by you
2. Cover Non-Medical Expenses: Your policy won’t cover non-medical costs, so you’ll need to pay those separately.
3. Co-pay or Copayment: Any co-payment that has been requested by your insurance company is to be borne by you.

Can I Carry All The Original Documents With Me If I Have Applied For Cashless Facility?

NO, you need to submit the documents listed below Before you leave, all medical documents, including lab reports, claim forms, discharge summary, and the final bill so that the file is dispatched to your insurance company or TPA (for final settlement).

After you provide these documents, the hospital will send them to the TPA (Third Party Administrator). The TPA will review them, process the claim, and make payments based on the policy terms and actual costs.

Sanction Approved During Pre Authorization Is The Final Approval?

NO, typically, the TPA approves part of the expenses first. Once the hospital submits the final bill and other documents, the TPA will review and approve the full amount. Hospitals may request additional approval from the TPA if needed during treatment.

What Is Medical Reimbursement?

Medical reimbursement is a process in which a patient first pays the hospital expenses and later claims the eligible amount from their insurance company, employer, government scheme, or other authorized organization by submitting the required documents.

How Is Medical Reimbursement Different From Cashless Treatment?

• Cashless Treatment: The insurance company directly pays the approved hospital expenses to the hospital.
• Medical Reimbursement: The patient pays the hospital bill first and later claims reimbursement from the insurance company by submitting the required documents.

What Documents Are Usually Required For Medical Reimbursement?

The following documents are generally required:

• Insurance Claim Form (Part A & Part B)
• Original Hospital Bills
• Payment Receipts
• Discharge Summary
• Investigation Reports
• Prescription Copies
• Pharmacy Bills
• Indoor Case Papers (if required)
• KYC Documents
• Any additional documents requested by the insurer

What Is The Reimbursement Process?

• Step 1: Complete Treatment & Discharge: The patient undergoes treatment and receives final discharge from the hospital.
• Step 2: Collect Original Documents: Collect all original bills, receipts, discharge summary, investigation reports, and supporting documents from the billing department.
• Step 3: Verify Documents: Check that the patient’s name, admission date, discharge date, diagnosis, and billing details are correctly mentioned on all documents.
• Step 4: Fill the Claim Form: Complete Part A and Part B of the reimbursement claim form provided by your insurer or employer.
• Step 5: Submit the Documents: Submit all required documents to the concerned insurance company, TPA, employer, or government authority within the prescribed timeline.
• Step 6: Claim Verification: The insurer/employer may verify the submitted documents and seek additional information from the hospital if required.
• Step 7: Reimbursement Approval: Upon successful verification, the approved reimbursement amount is credited to the claimant’s bank account as per applicable policy terms.

Who Can Apply For Medical Reimbursement?

Medical reimbursement can be claimed by:

• Individuals covered under a health insurance policy
• Employees receiving medical benefits from their employer
• Government employees covered under reimbursement schemes
• Beneficiaries of approved health scheme

When Should I Apply For Medical Reimbursement?

You should apply for reimbursement after discharge from the hospital and after collecting all necessary documents. Claims should be submitted within the timeline specified by your insurance company, employer, or reimbursement authority.

Will The Hospital Submit My Reimbursement Claim To The Insurance Company?

No. In most reimbursement cases, the patient or their representative is responsible for submitting the claim documents to the insurance company, TPA, employer, or government department.

How Long Does Reimbursement Take?

The processing time varies depending on the insurance company or reimbursement authority. Once all required documents are submitted and verified, the approved amount is generally credited directly to the claimant’s bank account.

What Happens If Some Documents Are Missing?

Missing or incomplete documents may delay the claim process or result in rejection of the claim. Patients are advised to carefully check all documents before submission.

If A Duplicated Copy Of Documents Like Indoor Case Papers (ICP) Is Required What Is The Requirement & Process To Receive It?

The following documents are required:

1. A) Duly signed Indoor Case Paper Request Form / Consent Letter
2. B) Copy of any one valid Photo Identity Proof:

• Aadhaar Card
• PAN Card
• Driving License
• Passport

The request can be submitted to the Medical Records Department.

Can I Keep Copies Of My Documents Before Submitting Them?

Yes. Patients are strongly advised to keep photocopies or scanned copies of all submitted documents for future reference.

Will I Receive The Full Amount Spent On Treatment?

Reimbursement depends on the terms and conditions of your insurance policy, employer’s medical benefit scheme, or government reimbursement rules. Certain expenses may not be covered and deductions may apply.

What Should I Do If The Insurance Company Asks For Additional Documents?

If additional documents or clarifications are requested, contact the hospital’s Billing Department or Medical Records Department. The hospital will assist in providing eligible records as per hospital policy.

Whom Should I Contact For Assistance Regarding Reimbursement Documents?

For assistance regarding reimbursement files, duplicate bills, discharge summaries, indoor case papers, or medical records, please contact the Hospital Billing Department or Medical Records Department at Info@jinkushalcardiaccare.com or call us on +91 88502 64251 during working hours (9:30am to 5:30pm Mon-Sat).