What is the procedure to avail cashless facility?

Cashless facility can be availed at a network hospital of Vision Insurance TPA Co Pvt Ltd, for treatment as per medical advice. Insured policy holder needs to present a copy of their TPA ID card and Identity proof at Hospital reception. Pre-authorization form has to be filled which has two parts i.e. information related to patient and Insurance Policy and information related to medical aspect which needs to be filled by the Hospital Dept and treating doctor. The Hospital shall fax or mail the completely filled form to the Office of the TPA. The TPA, shall process the case within 2 hours and revert to the hospital with the initial authorization letter for approval or with a rejection letter for request for Cashless facility as the case may be. In case of approval of cashless facility, enhancement can be sent to hospital as per applicable policy T & C.

In case of planned hospitalization, pre authorization can be sought in advance. The Hospital needs to send a request for the same to TPA, atleast 48 hours in advance before the date of admission. Approval, once given is valid for 15 days. In case of emergency hospitalization, the pre-authorization request needs to be sent within 24 hours from the time of admission.

Does “Cashless” hospitalization mean that I do not have to pay any amount to the hospital while getting discharged ?

No. As per the applicable Policy T & C, the policy holder needs to pay at the hospital, the bill for non medical expenses and co-pay amount (if applicable). Further, Insured has to pay at the Hospital, any difference of amount i.e. any difference between the final bill and approved amount.

What is the minimum time limit for stay in the hospital if I wish to lodge a claim under the Policy ?

There has to be a Minimum of 24 hours of hospitalization, on medical advice and with active line of treatment. However, in case of hospitalization qualifying under the Day-care procedure, the period of hospitalization may be less than 24 hours. A list of specific ailments requiring Day-care procedures are named in the policy. Examples are procedures of Dialysis, Chemotherapy, Cataract, Radiotherapy etc.

What happens to the Cashless facility, if the cost of treatment in Hospital exceeds the Sum Insured available in the insurance Policy ?

In such an unfortunate event, the policy holder shall bear the difference of amount i.e. the authorized credit limit and the actual cost of hospitalization and pay the same to the Hospital directly. The TPA shall inform the hospital about the Sum Insured available under the policy so that Hospital bill can be settled with ease and discharge formalities be done without any discomfort to the Insured.

What is the procedure of Reimbursement of claim?

After having availed treatment in a network or non-network Hospital, the Policy holder shall submit to the TPA, the original hospital bill, receipts, discharge summary and all claim documents together with a duly completed Claim form, original Cancelled cheque and bank details for ECS on the ECS Form. The claim form can be downloaded from website www.vision TPA.com. The Claim file can be sent by courier to the Office of the TPA or the same can be submitted by hand against an acknowledgement. However care should be taken to observe the TAT as specified by the Insurance Co and arrange to submit the entire claim documents within the specified TAT.

How can claim be intimated on reimbursement basis ?

Claim can be intimated within 24 hours of hospitalization, by visiting the office of the TPA with a written note which bears the Policy no, details of the Insured patient, date of hospitalization, nature of illness, estimated amount of claim etc. Intimation can also be done by sending information to:  [email protected] TPA.com or with a phone call to our toll free no. 1800-419-9982 on a 24x7 basis.

Is it possible to claim Medical expenses incurred before and after hospitalization ?

Yes. It is possible to claim medical expenses incurred 30 days before and 60 days to 90 days (as specified in your policy), provided they are related to the ailment/accident for which the main hospitalization took place. Such expenses are termed as pre and post hospitalization expenses. The procedure to claim the amount is by submitting a claim form together with the relevant Policy details, original bill and receipts, medical diagnosis and advice, diagnostic film ,X ray films and reports, discharge Summary etc.

Is there a TAT to process the reimbursement Claim?

Yes. The TAT to process the claim file is 30 days from receipt of complete set of claim documents in the Office of the TPA.

Will the TPA intimate me the claim status?

Yes, The TPA shall send updated status of the claim file from their data base, to insured on their registered Mobile no or Email ID or whatsapp.

Is it possible for me to check the claim status on my own?

Yes. You can log-in to your account in our web portal or our App or you can call our Customer-care Center to check the claim status.

What are shortfall documents (S/F) and how can they be sent to the TPA?

Query letter for Shortfall documents is issued after initial processing of the claim file to call for certain necessary claim documents or clarifications which are mandatory to process and finalize the claim file. Insured has to respond and arrange to send the same by courier post or they may visit the office of the TPA and hand over the required documents against acknowledgement.

Contact Us

  • Vision Digital Insurance Tpa Pvt. Ltd., Time Square Building 3rd & 4th Floor, Sushant Lok-1, Block-B, Gurugram – 122002
  • 0124-400-3171
  • 1800-102-9982
  • 1800-419-9982 (Senior Citizen)
  • [email protected]

Follow us on social media

Developed & Maintained by eiCORE Technologies