MEDICLAIM & TPA

Most Health Insurance policies do offer cashless hospitalization facility through a Third party Administrator (TPA). However, you will be eligible for cashless hospitalization, subject to the other terms and conditions mentioned in your policy being fulfilled.

Hospital has a limited role in cashless hospitalization. The hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization.

Your approval can be denied at times due to unexplained reasons like :

• 1st year exemptions
• Pre existing ailments
• Specific exclusions (accident due to drunken driving) etc...
• Psychosis
• Admission only for investigation

However, you will need to bear in mind that the Suyash Hospital is only a facilitator and can in no way influence the decision on the approval. The approval can be turned down, whenever there is a denial of authorization from TPA, the beneficiary has to clear the Hospital bill and go for compensation.

In case of delay in receiving the approval or when you cannot wait for receiving the approval owing to medical urgency you can undertake the treatment by paying the necessary cash deposit.

Excess amount of the bill apart from authorization/approved amount from TPA Company have to be paid by the beneficiaries.