Insurance & TPA

Cashless claims shouldn’t feel complicated—Holy Family Hospital’s Insurance & TPA support helps with approvals, documentation, and coordination, so you can focus on recovery.

  2. Patient Portal
  3. Insurance & TPA

 Cashless Planned Admission
 When to Apply

  • Submit the Preauthorization Form at least 4 days prior to the scheduled date of admission.
  • Submission timing: 9:00 AM – 2:00 PM (Monday to Saturday).

Preauthorization Form – 2 Parts

  • General Information (Patient Details Section)
    • This section must be completed by the patient or the primary insured.
    • All personal, policy, and contact details should be filled in accurately and completely.
    • The TPA Help Desk will provide necessary guidance and assistance, if required.
  • Medical Information
    • To be completed and duly signed by the treating doctor.
    • The doctor available at the TPA desk may assist, if required.
    • Please carry all relevant medical reports and consultation papers.

Required Documents

  • Insurance ID Card
  • Admission Note & Consultation papers
  • Relevant Investigation reports
  • Preauthorization Form (duly filled and signed)
  • Photo ID & Address proof (Patient & Primary Insured)
  • Recent passport size photograph (Policy Holder)

What Happens Next?

  • The TPA Help Desk will forward all documents to the respective TPA / Insurance Company for processing.
  • The TPA / Insurance Company may respond with:
    • Initial Approval
    • Query (request for additional information/documents)
    • For Room eligibility kindly confirm with your Insurance Company or insurance agent.

Patients/relatives are advised to contact the Hospital TPA Help Desk to check claim status.

Immediate Treatment

  • In emergency cases, treatment will commence without delay.
  •  The cashless process must be initiated within 24 hours of admission.

Deposit

  •  A deposit is required at the time of admission as per hospital policy (depending on type of surgery or category of admission).
  • The deposit is refundable as per hospital refund policy for cashless patients.

Preauthorization Form – 2 Parts

  • General Information (Patient Details Section)
    • To be completed by the patient or primary insured with accurate policy and personal details.
  • Medical Information
    • To be completed and signed by the treating doctor. (The TPA Help Desk will assist in completing and submitting the form.)

Required Documents

  • Insurance ID Card
  • Admission Note & Consultation papers
  • Positive  Investigation reports and current ailment 
  • Preauthorization Form (duly signed by the treating doctor)
  • Photo ID & Address proof
  • Passport size photograph (where applicable)
  • Cancelled cheque of the patient’s bank account (for refund processing)
  • If MLC case ( MLC/FIR COPY)

Process

  • The TPA Help Desk will submit the required documents to the respective TPA / Insurance Company for approval.

If Bill Exceeds Approved Amount

  • An estimate for the additional amount will be sent to the TPA / Insurance Company for enhancement approval.
  • If enhancement is not approved, the patient will be required to pay the amount exceeding the sanctioned limit.

If Sum Insured Is Exhausted

  • If the TPA / Insurance Company informs that the sum insured is exhausted, the patient must pay the amount exceeding the available coverage.
  • The discharge process will continue under the TPA / Insurance category.

Important Notice

  • Authorization for cashless hospitalization is provisional and subject to final approval.
  • The TPA / Insurance Company reserves the right to deny the claim during treatment or even after discharge.
  • In such cases, the patient will be responsible for payment of hospital bills as per the undertaking signed at the time of admission.

If Bill Exceeds ₹1.5 Lakh of Initial Approval

  • The hospital TPA team will send the billing statement along with treatment details for additional cashless enhancement.
  • The patient’s relative is required to follow up with the TPA for additional approval.
  • If additional authorization is not received within 24 hours:
    • The patient will be required to make an interim payment.
    • The same will be refunded at discharge as per hospital refund policy (if approved later).

Queries from TPA / Insurance

  • Hospital-related queries will be addressed internally by the TPA team.
  • If clarification or documents are required from the patient, the TPA team will inform the patient/relative accordingly.

Final Approval

  • On the day of discharge, the final bill and discharge summary will be submitted to the respective TPA / Insurance Company for final approval.
  • Discharge formalities will be completed upon receiving final authorization.
  • There can be a query at the time of discharge because of which the discharge can get delayed.
  • TPA formalities cannot be started on the day of discharge.
  • Final approval from your Insurance and TPA usually takes about 3 to 4 hours though it can vary depending on specific cases.
  • The patient must wait for the final approval even if the sum insured is exhausted.
  • If any patient / patient relative does not want to wait for final AL from their concerned TPA and Insurance and want to leave the hospital, in such cases the patient relative needs to pay the hospital final bill and go for reimbursement.”

Refundable Security Deposit

  • Once the final insurance settlement is received, we will refund the patient's deposit. Please be advised that any deductions noted in the final approval will be adjusted against the refundable security deposit, and the remaining amount will be refunded accordingly.

Non-Payable Expenses

  • The patient is required to settle all non-payable expenses, as these are not covered under the insurance policy.

Documents & Reports

  • Original hospitalization documents and reports will not be handed over to the patient, as they are required to be submitted to the TPA / Insurance Company along with the final bill.
  • A copy of the final bill may be collected from the admitted floor.
  • Photocopies of reports (including pending reports) may be collected from the Report Counter after 7 days of discharge.