Steps followed in admitting and discharging patients under Insurance schemes:
During admission:
Patients who had been advised for admission by the treating doctor are insured with any insurance company/TPA, patients/relatives are directed to the insurance section.
The incharge of the insurance section will check whether the particular TPA/insurance company is having agreement with ANNAMMAL HOSPITAL. If so, it will be proceeded for cashless hospitalization for inpatient treatment.
A preauth will be sent through email to the TPA for authorization of treatment. Simultaneously the patient/relative will be counselled about the cashless hospitalization and the other non-medical expenditure as per IRDA guidelines that cannot be claimed.
Authorization for insurance covered patients has to be obatained during the time of admission. In case of emergency patients, get emergency number from the TPA detailing patient’s condition.
If the authorization is not approved under any circumstances, it will be immediately informed to the patient/attender. The patient is advised to continue the treatment under payment category and advise to apply for reimbursement from the TPA.
During discharge:
When the treating consultant orders to discharge the patient, concerned ward nurse checks for all the bills (pharmacy, investigations and other procedures if any) during the stay of patient of patient and hand over the patients Medical record to the Insurance incharge.
Now the Insurance in charge prepares on the bill based on the tariff and conditions agreed between the hospital and the concerned TPA.
The patient’s signature is taken on the bill as token of acknowledgement of services billed
The Insurance in charge emails the bill and the discharge summary to the TPA
If full authorisation is received patient is discharged by following the normal procedure.
The Insurance in charge requests the patient to clear any amount due towards non-medical expenses (ambulance charges, telephone charges etc) and amount exceeding the permitted coverage for his/her insurance towards medical expense at the cash counter.
