The following procedure is adopted for Admission.
1. All planned admissions for hospitalization/surgical
procedures will be made only after the receipt of
Pre-Authorization approval from the concerned TPA/Insurance
2. Pre-Authorization form for all Mediclaim policyholders
shall be issued from Admission Counter to the patients
3. Admission Counter will validate the identity of the
patient prior to giving a request form of the concerned TPA/
4. The request form consists of 3 parts:
Part A: To be filled in by the insured Patient/Attender.
Part B: The patients shall then get Pre-Authorization
form filled in by the treating Doctor.
Billing counter shall enter the estimated cost of the
5. Filled in forms shall be submitted to Insurance Cell at
Reception counter along with photo ID for processing with the
concerned Insurance company/TPA.
6. During the off duty hours of Insurance Cell, the filled in
form shall be submitted at Billing for processing.
7. The request will be submitted to the concerned TPA/
Insurance Company, the Turn Around time for authorisation is
approx 6-10 working hours.
8. The TPA/ Insurance Company will send Approval/ Denial
Letter and the print out of the same will be available at the
9. If approved the Approval letter will also indicate the
amount upto which the TPA will settle the bill directly with
10. After receiving Pre-Authorization approval from the
concerned TPA/ Insurance Company, the patient can get admitted.
11. If the patient wants to get admitted prior to the receipt
of Pre-Authorization approval, deposit has to be made as per
the existing system of the Hospital, depending on the room
category and 90% of the cost of surgery, if any. This applies
to EMERGENCY admissions also. (Subsequently Pre-Authorization
would be requested from the TPA/ Insurance Company) as above.
12. Such deposits received will be refunded in cash (if it is
within 10,000/-) or by way of A/c payee cheque (in the name of
the patient only) on discharge or will be adjusted against
balance (if any) in the final bill on receipt of approval.
13. At the time of discharge if the final bill amount exceeds
the authorized amount, the consolidated final bill will be
processed with the concerned TPA for enhancement for further
approval or reconfirmation of the case which will take 3-4 hrs
from the time the final bill and discharge summary are
processed. We request you to bear with this delay in the
14. Payments are to be made in full, if Pre-Authorization is
not approved under any circumstances. Similarly, difference
amount in the bill (if any) not approved by TPA / Insurance
along with the non-medical expenses and non-reimbursable
charges shall to be paid by the patients at the time of
15. Please note t hat the rejection of the preauthorisation
request is only denial for cashless services and is no way to
be treated as denial of treatment. The insured can directly
settle the bill with the hospital, the insured retains the
right to get treated and submit the bill directly to the TPA
for subsequent reimbursement.
16. With regard to all TPA/ Insurance related issues,
decision of the Mallya Hospital Management will be final and