Re: HEALTH INSURANCE - iBa brokered policy

[Manickam Ravindran]

I had my cataract surgery on June26 at Aravind Eye Hospital CBE  and  request  for cashless treatment and pre authorisation was sent on 24 Jan by hospital.Approval was not recd  and when contacted,HITPA  ,the TPA  is telling ' under process.will update after 3 minutes parrot like thee times at 10,1 and 4 o clock respectively. To cut the long story short,I had tonremit the full amount to the hospital for Rs 36k and got discharged. The hospital is equally insensitive and asked to claim reimbursement from TPA. This is awarning to all ION pensioners.Keep your purse full and TPA will ditch you  and cashless treatment is a scam . I do not know whether mine is an isolated incident or the  the standard practice of TPA.Why not pensioners assn take up with IBA to blacklist HITPA  to save the agony of pensioners. 

Manickam Ravindran
9176607195

[MOHAN P]

Dear Shri Ravindran,

It is quite unfortunate to hear that your cashless claim for cataract surgery was not approved on time by HITPA,under IBA GMIS.

In  a normal process for a cashless treatment under IBA GMIS you are entitled to go for the same, in any  hospital partnered with your assigned TPA.In case of planned admissions you have to inform the TPA in advance through hospital insurance desk, with your Health ID card along with valid photo ID. Hospital may do the rest of the process  to get the approval from TPA. 

Once approved, you can undergo the treatment. Upon discharge, you will only need to pay for non-medical expenses and any co-payments or limits defined by your specific IBA policy.I do not know what has happened in specific case in above hospital.Any way hope that you might have already claimed for reimbursement.

Now a days we find that  in general  majority of the cases under different TPAs under IBA policy  for cashless treatment are found approved especially in such cases where amount of claim is pre fixed under policy cover.

Prior intimation and approval is necessary before undergoing treatment in planned admissions as per policy terms.

Regards

Mohan.P

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