TPA Rules and Regulations

• BAPS SHASTRIJI MAHARAJ HOSPITAL has tied up with the Third Party Administrators (TPA) to extend cashless facilities to the esteemed members of such TPA & Insurance Companies.
• All completed forms for cashless authorization must be submitted to the business development unit or TPA/Corporate handling Unit within 24hrs of admission with supporting documents.
• The cashless facility will be provided only to the extent of the approved amount as stated in the letter of authorization issued by the concerned TPA
• BAPS SHASTRIJI MAHARAJ HOSPITAL will provide an approximate estimate of expenses whenever required by the TPA after submission of the completed form for pre-authorization by the patient.
• BAPS SHASTRIJI MAHARAJ HOSPITAL will not be responsible if the TPA sanctions an amount lesser than what is stated in the estimate.
• In case the final bill amount exceeds the approved amount by the TPA, such excess amount shall be collected directly from the patient at the time of discharge .The same has to be followed in regard to the doctor’s/surgeon’s fees. Hospital will not be responsible in recovering or paying any such dues to the consultant.
• BAPS SHASTRIJI MAHARAJ HOSPITAL, will however submit all such documents as may be necessary for further enhancement of the initial or subsequent amount as sanctioned earlier.
• Only upon receipt of such enhancement letter, shall be patient be allowed to avail of the cashless facility.
• Charges for accepting of the higher category of room etc. shall be levied at actuals in the event of any delay by the TPAs in sending the letter of authorization or further enhancement.
• The patient must pay all the inadmissible expenses at the time of discharge. Such amount is to be paid even if it is well within the sanctioned limit. Identification of such inadmissible portion shall be at the sole discretion of the Hospital.
• In case of denial of cashless facility the entire amount has to be paid by the patient at the time of discharge. BAPS SHASTRIJI MAHARAJ HOSPITAL is not responsible in delayed discharge due to end movement denials.
• The patient fully understands that BAPS SHASTRIJI MAHARAJ HOSPITAL has no role in sanctioning the authorization amount for cashless facility. It is solely at the discretion of the TPA.
• Any disputes arising shall be dealt directly by the patient or nearest relative with the concerned TPA.
• The patient and his/her family fully understand that the payment has to be made to BAPS SHASTRIJI MAHARAJ HOSPITAL on demand in case the TPA/Company denies reimbursement to BAPS SHASTRIJI MAHARAJ HOSPITAL.