KARTHIK HOSPITAL (Child Care Centre) - Paediatric Care, Child Health, Cryo, Skin, General & Paediatric Surgery in Karthik Hospital at Madurai

Our high quality of service and patient satisfaction level coupled with value pricing, make us an ideal partner with many insurance providers and TPAs. We are also considered amongst the leaders in accurate and fast insurance document and bill processing. Karthik Hospital has a tie up with several leading Insurance companies and TPAs. Please contact the hospital for the latest insurance list.

We have observed that patients have several doubts while filling the application form for cashless and for reimbursements and also tend to miss certain important documents like insurance card while coming to the hospital. They are some general tips that we would like to provide for both cashless and reimbursement procedures and have also enlisted to procedures for both.

After your doctor has recommended admission, contact the admission counter and present your insurance card. They will advice you on how to proceed. The Insurance Card can only be used for inpatient admission which exceeds a minimum of 24 hours. It cannot be used for outpatient consultation / investigations. For some policies the card can also be used for day care procedures listed in the policy document. Please read your insurance policy for the details.
The preauthorization form needs to be duly filled by your doctor and you and the same is to be given to the Insurance coordinator at the hospital
Your form will then be faxed to the TPA / Insurance Company by the hospital. The decision on the pre-authorization request will be sent to the hospital directly. The case will be decided as per the policy terms and conditions.
In case of enhancement request, the interim/final bill along with case/discharge summary needs to be faxed to insurance company / TPA. The decision on the same will be conveyed to the hospital.
In some instances, more information may be required to take a decision on the pre-authorization request and the same will be conveyed to the hospital via fax. The hospital would need to revert to TPA / Insurance Company, who would then give the final decision after evaluating the pre-authorization request.

Once discharged after treatment, fill in the Claim Form, which can be downloaded from the Insurance Company / TPA's website. Certain fields need to be filled in by the treating doctor. Ensure the form is properly filled in by you and the doctor.
Please bring the filled form to the insurance desk at the hospital. They will assist you with getting the required signatures from the treating doctor.
Once the form is complete, courier the filled and stamped Claim Form to the Insurance Company/ TPA's office, along with the following documents.
1. Original detailed discharge summary
2. All payment receipt(s) in original.
3. Copy of Insurance card and supporting Photo ID (Wherever applicable)
4. Original Hospital Bill(s) with break up - Interim Bill and Final Bill.
5. Original Investigation reports and Bills
6. Pharmacy Bills with supporting prescription from the treating doctor.
Your Insurance company / TPA shall approve or reject the claim based on the terms and conditions of your policy.
On approval, the claim amount as approved by the Insurance company / TPA, it shall be reimbursed by cheque. If the documentation is incomplete, you would be intimated and the process shall continue. However, it is important that the said documents are sent within the prescribed Claim Intimation Period. In case the ailment is not covered under the Member's Policy Terms and Conditions, the claim request shall be rejected.

HEALTH INSURANCE