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.