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Insurance, TPAs and Corporate Tie-ups

Overview

The importance of medical and health insurances can never be overstated. The third-party administrator (TPA) help desk at the Sir H. N. Reliance Foundation Hospital and Research Centre serves to ensure that patients can cash in their medical insurance in a seamless, stress-free manner. We accept insurance claims from a wide range of service providers. Our goal is to ensure that all our patients can avail our benefits in the most cost-effective way possible. Right from pre-authorisation to reimbursement, we are here to help!

  • Planned Admissions
  • At Admission
  • During Your Stay
  • At Discharge
  • Emergency
  • Refund Procedure
The Tower

For planned admissions, after consulting with a doctor at RFH, you will be advised on the expected date of hospitalisation. You must apply for approval of the estimated hospital expenses through your third-party administrator (TPA) at least 5–7 days before the date of hospitalisation.

If pre-authorisation has not been applied for in advance, or if the doctor advises immediate hospitalisation following, our TPA Help Desk will assist you with the preauthorisation procedure.

Normal working hours

  • Monday to Saturday 08:00 am to 09:30 pm
  • Sunday and Hospital Holidays 09:30 am to 06:00 pm
  • TPA Form Submission Timing: 10:00 am to 06:00 pm (Every Day)

Please Note:

The TPA Help Desk only facilitates the process and has no influence over the approval decision made by your TPA or insurance company.

Claim approval may be denied by your TPA due to the following reasons:

  • The medical condition is not covered under your insurance policy.
  • Insufficient information provided in the Pre-Authorisation Form (The TPA may request additional details).
  • You have exceeded the sum assured for the current policy year.
  • The waiting period, as outlined in the policy terms and conditions, has not been completed
  • Non-disclosure of pre-existing conditions
Pre-Authorisation Procedure:
Step 1:

Kindly contact the TPA Help Desk on the 1st Floor of the Tower Building. Visit the hospital’s website for information about the cashless claim processing and reimbursement procedure.

Step 2:

Collect the Pre-Authorisation Form, TPA Checklist, KYC Form of Policy Holder, and the TPA Undertaking Form from the TPA Desk or download them online. Make sure to have your health insurance card or policy document for the current year ready.

Step 3:

Fill in the Pre-Authorisation Form

Section 1: General policy details (to be completed by you, with assistance from the TPA Desk if needed).

Section 2: Treatment detail (to be filled in and signed by your treating doctor) The TPA Checklist & the TPA Undertaking Form are self-explanatory.

Step 4:

Submit the completed form (filled and signed), along with copies of the documents mentioned in the TPA Checklist to the TPA Help Desk or as a single pdf file of all your documents to rfh.tpa@rfhospital.org.. Ensure the subject line contains the ‘Patient's name, patient ID, mobile number, date of admission, and class of accommodation’.

Step 5:

Once verified, the TPA Help Desk will upload the documents on the insurance portal.

Step 6:

The TPA Help Desk will inform you of the approval/denial status via your registered mobile number

Step 7:

Any difference between the final TPA-approved amount and the total hospital bill amount is payable by the patient.

Empanelled TPAs and Insurance Companies

Click here to download the TPA Checklist and the TPA Undertaking Form.

For any queries, Click Here or email us at rfh.tpa@rfhospital.org.

The Tower

In case of partial approval, the patient is responsible for the difference between the estimate and the TPA-approved amount.

If case of queries, no approval confirmation or a denial of the cashless claim, the patient must pay the full admission deposit or surgical estimate.

The Tower

For long stays or bills exceeding the initial estimate, the TPA Desk will request an enhancement of the pre-approved amount. Please approach the TPA Desk for any updates or changes to your plan.

The Tower

The difference between the final approved amount and the total bill amount must be paid by the patient.

Non-medical items (as per the IRDAI guidelines), co-payment, bed eligibility–related deductions, and other policy-based deductions are payable by the patients (irrespective of the final approved amount mentioned in the approval letter).

10% of the final approved amount will be collected as security deposit, which will be adjustable against any shortfall in the TPA’s final settlement/payment.

If the TPA reduces the final approval post discharge, then the difference is payable by the patient.

In case of denial, the entire bill will have to be settled at discharge. The hospital will not be responsible for any cashless claim denials/deductions.

The Tower

In case of an emergency hospitalisation, seek treatment for the patient immediately. The TPA Desk will fast track your case and you are likely to receive approval within 6 hours during working days depending on your insurance company.

Step 1:

Show your Health Insurance Card and fill in the Pre-Authorisation Form.

Step 2:

The Corporate/TPA Desk at the hospital will expedite the cashless claim process. If you cannot wait for the approval, you can pay the deposit (if required by the hospital) to start treatment and seek reimbursement later.

Step 3:

The processing time for an emergency is 6 hours but may vary depending on the insurance company. You should follow up with your TPA to check the status of the request.

The Tower

Any excess admission deposit will be refunded within 10 working days post- discharge.

The security deposit will be refunded ONLY after receiving the final approved amount AND Settlement Letter from the TPA/insurance company. If deductions exceed the security deposit, the balance is payable by the patient.

To process the refund through RTGS/NEFT, please provide a cancelled cheque and your PAN number.

A) Part A & Part B Forms of your insurance company
B) All Original Investigation Reports
C) Original Bills and Discharge Summary
D) Indoor Case Papers (if required)
For queries, call 1800221166 (Ext no. 8114/8115) from 10:00 am to 06:00 pm.

The form is available on your insurance company’s website or through your insurance agent.

The Part B Form should be filled in by the TPA Desk after patient’s discharge.

It is available in the Medical Records Department or you can send a request email to rfh.mrd@rfhsopital.org.

Patient's Signed Consent Letter or Indoor Case Paper Request Form AND a copy of your Pan Card, Aadhaar Card, or Driving License.

Yes, charges are applicable. A voucher can be made from any OPD cash counter.

You can receive your Indoor Case Papers from the Medical Record Department within 2 working days from the date of application.

We hope that this information helped you.

We wish you a speedy recovery.

Sir H. N. Reliance Foundation Hospital

Indoor Case Paper Request Form

Reimbursement Form

FAQs on the Health Insurance Claim Process

The list of empanelled TPAs is available on the hospital website.

View

If you have corporate insurance, your insurance card will typically display a Corporate ID, Employee ID, or your company’s name/logo. For individual insurance, these identifiers won't be mentioned on the insurance card.

The hospital room category is usually determined by your policy’s coverage, with a tariff matching up to 1% of the policy amount. However, this is subject to your policy terms and conditions.

Coverage for diagnostic tests, OPD consultation, and other tests done before admission will depend on your policy terms and conditions. Once admitted, all costs incurred during the stay are usually reimbursed as per the policy terms and conditions. You have to go for reimbursement for pre and post hospitalization expense.

The coverage of treatment depends on the terms and conditions of your policy. Please consult your agent or insurance company for specific details.

  • Insurance Form, duly filled by the doctor & the patient/legal representative
  • Valid TPA Card/Insurance Policy
  • Govt.-issued ID proof (Aadhar, PAN, Voter ID, or Passport) of the patient and policy holder
  • Employee ID Card (for corporate policy holders)
  • Doctor's Admission Note
  • Relevant medical documents (e.g., Latest investigation reports & doctor prescriptions)
  • MLC/FIR & Incident Report (if applicable)
  • Duly filled and signed KYC Form, along with one passport-size photo and a copy of the proposer’s ID proof– (i.e., the main insured). Please note that this requirement is from the TPA/Insurance Company.

Locate the kiosk next to the Help Desk.

  • Select the TPA option.
  • A token number will be issued.
  • Wait for your token number to be called.

Pre-authorisation typically takes 4–5 hours, depending on the TPA.

It will depend on the TPA-approved amount and the hospital’s estimated deposit. If the TPA-approved amount is less than the estimated deposit, you will need to pay the difference. This amount will be refunded except the 10% security deposit upon discharge after receiving final approval based on the bill.

In the case of full approval, a security deposit of 10% of the approved amount will be required at the time of admission.

  • For planned admissions, prior approval from your TPA is necessary
  • For emergency admissions, you must pay the required deposit and seek TPA approval.
  • The cashless facility is subject to policy terms and conditions. The hospital is not responsible for TPA’s refusal or partial approval.

The TPA Help Desk is only a facilitator and can in no way influence the TPA’s decision on claim approval. Your TPA may reject the claim owing to multiple reasons; the most common ones are:

  • If the hospitalisation is for observation & investigation purposes.
  • If the particular ailment/disease/treatment is found not covered under policy terms and conditions (waiting period or permanent exclusions).
  • If it is found that the treatment can be done on an OPD basis.
  • If it is found that no active line of treatment is available (pre-existing diseases [PEDs]).
  • If you have exhausted the sum assured for that year.

You can send the pending documents to the TPA Department in the hospital or email them to rfh.tpa@rfhospital.org along with the patient’s name and ID number as well as contact details.

You need to inform the TPA staff to process an enhancement request for the additional amount.

You can check your claim status by calling your insurance company’s call centre, visiting the TPA’s website, or contacting the hospital’s TPA Desk.

Treatment-related queries from the TPA, will be answered by your treating physician. For other queries pertaining to indoor case papers can be shared with the TPA Desk which will help you in obtain a hard/scanned copy. Queries related to the policy holder’s personal documents, KYC, or previous consultation papers can also be submitted to the TPA Desk.

  • Discharge
  • During Hospital Stay
  • Emergency

As per the hospital policy, all final bills are sent to the TPA at discharge for final approvals. The approval amount at discharge is the final amount that the TPA agrees to pay. There may be deductions for non-medical expenses or other expenses from the final bill. This process may take 3–4 hours depending on the response time of the TPA post submission of the bill.

Yes, the patient or family needs to pay the difference between the final bill and the insurance approved amount, plus a security deposit of 10% of the approved amount.

Example: If the final amount is ₹5,00,000 and your final insurance–approved amount is ₹2,50,000 you need to pay the remaining ₹2,50,000 along with a security deposit of ₹25,000.

Note: Only up to ₹1,99,000 can be paid via cash; the remaining amount should be paid via NEFT/DD/card payment/online payment.

It usually takes 3–4 hours to receive the final confirmation of discharge from the TPA.

You need to submit the Refund Declaration Form along with a cancelled cheque for a refund through NEFT/RTGS.

In case of an emergency admission, inform the TPA Desk within 24 hours.

If you have not applied for pre-authorisation sufficiently in advance or if the treating doctor advises immediate hospitalization, contact our Help Desk (Phone No.: 1800221166 ext. 8114/8115). They will assist you through the pre-authorisation process. Alternatively, the ER PE staff or the Floor Coordinator will assist you.

(a) Part A & Part B Forms from your insurance company

(b) Original Investigation Reports

(c) Original Bills and Discharge Summary

(d) Indoor Case Papers (if required)

Please check your insurance company’s website or contact your insurance agent.

Contact Us

For any TPA assistance, kindly contact TPA desk

1800221166 (Ext. 8114 / 8115)

Resources

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  • TPA Forms
  • Empanelled Insurance
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