Direct Billing: Direct billing is when we charge the insurance company directly for the cost of your procedure. Many (not all) of the insurance companies we have contracts with will allow us to do direct billing. Otherwise, you will need to pay for the procedure first (usually with a deposit), and be reimbursed by your insurance company later. In addition, there may be differences in your plan depending on if you are having an Outpatient or Inpatient procedures.
Reimbursed billing :Many plans require you to pay first, and be reimbursed later. Reimbursed billing will be the majority of billing methods for any insurance company we do not have a contract with.
In case of reimbursement, all the original papers like discharge summary, investigation reports and bills have to be sent to the concerned TPA by the patient, and then the claim will be settled.
Step 1: Establish contact with the Corporate Help Desk at the hospital
Step 2: At the Corporate Help Desk, you need to present the original Health Insurance card issued to you by your TPA
Step 3: Collect the pre-authorization forms pertaining to your TPA
Step 4: Your pre-authorization form will have two sections
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
Step 8: At the time of admission, you shall be required to make a deposit payment, which shall be refunded post discharge, subject to completion of all formalities
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 with deduction if any.
Also Note :As per the system adopted by most Health Insurance Companies/TPAs, the final sanction is sent only after getting the discharge summary and the Final Bill. Hence even after the discharge advice of the doctor, patient may have to stay in the hospital for further few hours till such sanction is received by the hospital.
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.