Understanding Cashless Hospitalization at Wockhardt Hospitals

Monday, March 9, 2009

We have often come across some guests at our Hospitals trying to understand the concept of "Cashless Hospitalization".

Cashless hospitalization means that as an Mediclaim policyholder or if you are holding any kind of medical insurance, one will not have to run around paying off the hospital bills and getting kind reimbursed later. With Cashless Hospitalization,the policyholder will be able to avail of medical services at designated hospitals and his bills will be settled through TPAs (third party administrators) who will additionally offer a 24 hours toll free helpline, access to physicians, specialties, diagnostic centers and ambulance services.

There has been some concern and confusion regarding how cashless Hospitalization work. We decided to ask our Help desk experts at our Wockhardt Hospitals and thought of sharing some information which should go a long way inc clearing some of the confusion on Cashless Hospitalization. This guide will run you through various procedures of your medclaim policy particularly ' Cashless Hospitalization" at Wockhardt Hospitals.

Please contact the Wockhardt Health Insurance Helpdesk ( for Bangalore and Mumbai).The Wockhardt help desk would validate the identity of the patient prior to giving a request form of the concerned TPA /insurance Company

The request form consists of 3 parts

Part A : to be filleld by the insured /patient with assistance from the helpdesk
Part B : To be filleld by the treating doctor at the hospital in detail
PartC : To be filled up by Wockhardt Hospitals

  • The completed request form should be submitted at the Wockhardt Hospitals insurance helpdesk
  • The request will be submitted to the concerned TPA,the turnaround time for the authorization is approximately 6-24 hours.
  • The TPA will send an authority or a rejection latter as the case may be ,directly to the hospital and the printout of the letter will be available at the helpdesk.

If approved ,the authority letter will indicate the amount upto which the TPA will settle the bill directly with the hospital.

In case the cost of the hospitalization is expected to cost more than the amount specified in the letter /pre-authorization form a request for enhancement will be sent to the TPA which will be monitored by the help desk personnel.

Authority letter are valid only for the period of Hospitalization sought as per request.Please inform the help desk if there is any change in these dates in case of planned hospitalization.

Final Discharge/Billing Turnouround Time:

The final billing clearance from the TPA could take atleasy 4 hours from the time your consulting doctor discharge .

Circumstances under which a request for cashless hospitalization can be rejected

  • The ailment for which hospitalization is sought is not covered under that particular insurance policy for reasons like pre-existing, specific exclusions,etc
  • If the hospitalization is only for investigation purpose
  • The insured has already exhausted his insurance cover for the year.

Please keep in mind that the rejection of the request for pre-authorization is only denial of cashless service and is no way to be treated as a denial of treatment.The insured retains the right to get treated and submit the bills to the TPA for subsequent reimbursements.

Some services are not reimbursable as per standard conditions
  • Admission charges
  • Registration Charges
  • Ambulance charges
  • Nutrition Planning charges
  • Direct charges
  • Telephone charges
  • medical Certificate
  • Birth Cerficate
  • Medical Legal charges
  • Thermometer
  • Admission Kit
  • Walker
  • Cervical collar
  • Lumnro sacral belt
  • Pelvic Traction belt
  • Crutches
  • Arm sling
  • knee Braches
  • Abdominal belt
  • Spectacles
  • Nebulizer Kit
  • Oxyzen Cylinder
  • Urine Can/Commode
  • Water bed
  • Cd/Video Cassette
  • Medication/treatement not pertaining to the illness for which the patient is hospitalised
For more information and clarifications on our Cashless Hospitalization ,you can contact our helpdesk at bangalore at 080-66214179/66214171

If you want to share your experiences at Wockhardt Hospitals across India, or any other Hospitals on" getting your medical insurance" or going through "Cashless Hospitalization" at any Hospital,please write to us at enquiries@wockhardthospitals.net and or can comment at our blog here.

Posted by Wockhardt Hospitals at 12:26 AM  

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