+91 22 5095 4700


Insurance & TPA

If you have any questions regarding your insurance, please call

+91 22 6112 4812/15 or email tpa@somaiya.edu

K.J. Somaiya Superspeciality Centre provides the benefit of cashless hospitalization with a variety of insurance companies for the benefit of the patients. Please follow the process for cashless payments and pre-authorization with the hospital. We recommend, the patients' to check if their TPA/Insurance Company is covered and tied up with the hospital.

Important points to Note

Possessing a TPA identity card does not automatically entitle the patient to get Cashless benefit. A certain defined procedure for obtaining sanction from the TPA has to be followed.

Empanelled lnsurance CO. & TPA's

EMPANELLED INSURANCE COMPANIES

Apollo Munich

Bajaj Allianz

Cholamandalam

National Insurance

 

HDFC Ergo

ICICI Lombard

ICICI Prudential

MAX Bupa

 

Future Generali

Reliance General

Religare

Royal Sundaram

 

United India

Star Health

Oriental Insurance

IFFCO-TOKIO

New India

TPA's

Alankit Health & Wealth

Anmol Medicare

Anyta Health

Bajaj Allianz

Dedicated Health Care

E-Meditek

Ericson

EwA

Genins India

Good Health

Happy TPA

Health India

cholomandalam

Vipul Medcorp

Md india

Medi Assist

Paramount LIC

Park Mediclaim

Raksha TPA

Rothshield

Sri Gokulam

TTK Services

Medicare

Med Save

SBI General

Heritage Health

Family Health

Focus TPA

Process

The preauthorization forms of TPA tied up with the hospital can be collected from the TPA department of the hospital.

  • Step 1: Patient presents for admission
  • Step 2: Filling up of the Pre Authorization Form by treating doctor and sending to TPA/Insurance Company Concerned and waiting for initial approval. The estimated amount of expenditure is mentioned here.
  • Step 3: TPA/ Insurance Company may revert back with queries if any which are replied by the hospital.
  • Step 4: TPA/ Insurance Company sends provisional approval as per patient’s policy details.
  • Step 5: Patient is allowed to undergo treatment at the hospital as per approval
  • Step 6: Prior to discharge the final bill, treatment details & the discharge summary of the patient is sent to the TPA/Insurance Company for final approval.
  • Step 7: TPA/Insurance Company may have multiple queries which have to be replied to by the hospital. Approval is not sent till all queries have be answered and the TPA/Insurance company is totally convinced that treatment has been done as per approval.
  • Step 8: After final approval is received the patient is clear for discharge. This process takes atleast 4 - 6 hours depending on the TPA/ Insurance company.
 

How to identify your TPA?


  • The TPA will issue you an identity card which will indicate the name of your TPA.
  • On your insurance policy, on the lower left hand corner of the policy and backside, the name of the TPA will be printed.
  • Your insurance agent will be able to inform you accurately.
 

In Case of Denial

On denial of Cashless hospitalization by the TPA, the patient will be treated as a cash paying patient and will have to make the necessary payments as per hospital policy.

 

Reimbursement Process

For patients who do not avail the benefit of Cashless hospitalization or whose claims are denied for Cashless, please contact your respective TPA along with patient’s Discharge card, all Original reports, claim form of insurance company and hospital bills for reimbursement. If the Indoor case papers are required, kindly make an application in the TPA during working hours.

Disclaimer

K.J. Somaiya Superspeciality Centre reserves the right to deny the Cashless Facility to any of the Card Holders of Above Mentioned TPA’s. TPA department will assist you and guide you in the process of obtaining the cashless facility from the TPA / Insurance company. However the primary responsibility of obtaining the authorization would be of the patient / relative.

 

Need assistance?

Call us at +91 22 5095 4700

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