FAQ

Should I bring my insurance card with me?
- Yes, the information on your insurance card is needed to file a claim with your insurance company or companies. When you register we will ask for information about your insurance coverage and have you sign a form authorizing your insurance company to assign the benefits.
- You should also be aware that your insurance card contains important information about the co-pay amounts you are responsible for on different types of service. If possible, please be sure to review your health insurance handbook prior to your trip to the hospital.
- Remember, the registration process goes much faster when you bring complete insurance information with you.
Why do I have to show my insurance cards every time I come to the hospital?
- To better serve our patients, we like to make sure that we have accurate and up-to-date information on file.
How will I know if a service is covered by my insurance?
- Policies vary widely on which procedures, services or items an insurance company will cover. Because policies are often customized, we do not always know what your policy covers. In order to maximize your health insurance benefits, it is very important that you familiarize yourself with the policies and benefits outlined in your health insurance handbook.
What is pre-authorization and what does this mean?
- Pre-authorization is the approval by your insurance company to proceed with surgery or a special procedure. You must verify that this is done by the executives in the Insurance Department.
- Obtaining pre-authorization does not guarantee that your insurance company will pay the bill.
- Hospitalization happen fewer than two circumstances – Planned and Emergency.
- Pre-authorization approval of the estimated hospital expense is a must to avail this facility.
- Planned Hospitalization: In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must have applied for an approval of the estimated hospital expenses directly with your TPA at least 4-5 days prior to the date of hospitalization.
  In case you have not applied for a pre-authorization sufficiently in advance or if the doctor treating you advises you to get hospitalized immediately after the consultation, our Insurance Cell will assist you through the pre-authorization procedure. However, you will need to bear in mind that the Insurance Cell is only a facilitator and can in no way influence the decision on the approval. The approval can be turned down.
- Emergency Hospitalization: In case of emergency hospitalization, the Insurance Cell will take up your case on a fast track basis with your TPA of General Insurances and is likely to receive approvals within 24 hours during any working day. There is an exception for ECHS coverage which might take 48 hours to receive approval.
  For cashless treatment it is mandatory for the hospital to have an approval from your TPA. 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 as security. If you receive approval from your TPA after paying the cash deposit, you are entitled for refund of the cash deposit.
Am I eligible for cashless hospitalization facility?
- Most Health Insurance policies do offer cashless hospitalization facility and route your policy through a Third party Administrator (TPA). However you should be familiar with the terms- Network Hospital and Non-network Hospital.
- Network Hospitals are those hospitals that your TPA has an agreement with. In case of hospitalization, if you get admitted to a Network Hospital you will be eligible for cashless hospitalization, subject to the other terms and conditions mentioned in your policy being fulfilled.
- In case you are admitted to a Non-network Hospital, you will have to settle the bills directly to the hospital and then seek re-imbursement through your TPA.
Can I just walk into a hospital and get admitted for treatment free of cost?
- First, you need to be clear that there is no free treatment. It is just that, in the case of a cashless hospitalization, the insurance company will bear the cost of treatment either fully or partially on your behalf.
- Cashless hospitalization is a facility provided by most health insurance policies and enables an insured customer to obtain admission and undergo the required treatment without a direct payment. The assigned TPA will mediate between the healthcare service provider (Hospital) and the Insurance company and settle the bills on behalf of the insured customer.
- However it is important to understand the role of a Hospital in cashless hospitalization. The Hospital is only a facilitator and has no authority to approve or disapprove any request for cashless hospitalization. Certain protocols laid down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization will need to be adhered to strictly.
If no approval is obtained to bear the cost of treatment till the time of discharge at the Hospital;
- Cashless hospitalization is linked to the approval of the estimated expenditure on your proposed treatment. In case you do not get your approval you will need to bear the entire expenditure incurred on the treatment. Therefore it is always prudent to get the approval and then get yourself admitted. You could explain the benefits of getting the approval before the date of your admission to your treating doctor as well when he recommends an immediate admission.
- At Fatima Mata Mission Hospitals the Insurance Cell will not entertain any request for a refund of the amount paid if the approval comes after the process for your discharge has commenced.
What are the circumstances when a cashless hospitalization may not be entertained?
Normally your request for approval might be rejected when:
- The ailment for which hospitalization is being sought by you is not covered under your insurance policy for reasons like pre-existing ailment, specific exclusions (road traffic accident under the influence of Alcohol)
- Information contained in the pre-authorization form is insufficient for the TPA to arrive at a decision and further information is not available for various reasons. However the chances of rejection under this criterion are rare since the Insurance Cell at the hospital is experienced in complying with pre-authorization formalities and will advise you suitably
- You have exhausted your eligible Medical Insurance cover for the year.
What do I do if the actual medical expenses overshoot the pre-approved amount?
- In case of cashless treatment, there are chances that the total medical expense may overshoot when more complications are found or when the patient undergoes more than one surgery during the same admission.
- The Insurance Cell will apply for an enhancement on your behalf with the TPA and provide the necessary documentation. In case you have not exhausted your medical insurance limit, it is most likely that your TPA will approve the application for the enhancement – either for the requested enhanced amount or up to your insured limit after deducting the value already utilized by you during the year – whichever is less.
- If the TPA turns down the request for enhancement you will need to pay the amount incurred in excess of your approved amount directly to the hospital before the discharge.
Does cashless hospitalization cover all medical expenses?
- For complete details on the medical expenses that are covered, and those that are not covered, you need to go through your health insurance policy. However, in general, the expenses listed below are not reimbursable under cashless hospitalization.
  
  Visitors / Attenders Charges
  
  Non-medical Expenses.
  
  Vaccinations
These need to be settled by you directly to the hospital at the time of discharge
In case of treatment with re-imbursement, what are the documents the hospital requires from me at the time of discharge?
- All the original documents including bills, lab reports, discharge summary and claim form. All the original documents duly signed by you need to be submitted to the respective organisations.
List of TPS’s with whom Fatima Mata Mission Hospitals has a tie-up?
Fatima Mata Mission Hospital has a tie-up with several TPA’s. (Current list is given below). However this is dynamic and will change from time to time. Kindly contact the Insurance Cell for an updated list.
Medi Assist India TPA Pvt. Ltd.

Vidal (TTK) Healthcare TPA Pvt. Ltd.

Bajaj Allianz General Insurance Co. Ltd

DHS TPA India Pvt. Ltd.

Family Health Plan TPA Pvt. Ltd.

Good Health Plan Ltd.

Karunya Benevolent Fund (KBF)

ECHS

Medisep

Apollo Munich Health Insurance Co. Ltd.

Paramount Health Services TPA Pvt. Ltd.

Raksha TPA Pvt. Ltd.

Star Health TPA Pvt. Ltd.

Vipul Medcorp TPA Pvt. Ltd.

Cholamandalam MS Pvt. Ltd.

Ericsson TPA Pvt. Ltd

Religare Health Insurance Pvt. Ltd.

Bharat Sanchar Nigam Ltd (BSNL)

Aditya Birla

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