TPA AND CORPORATES
A Third Party Administrator (TPA) is an important link between insurance companies, you and us. A TPA's role is to provide administrative spport to the insurance companies for servicing their insurance policies.
However, it is important to understand the role of a hospital in cashless hospitalization. The hospital is only a facilitator and has no authority to approve/disapprove any request for cashless hospitalization. Protocols laid down by the Insurance Regulatory and Development Authority (IRDA) with respect to cashless hospitalization will need to be adhered to strictly.
You are the beneficiary of the insurance company and we request you to spare some time to understand the processing of insurance claims.
Insurance companies have appointed TPA's (Third Party Administrators) to give you the facility of cashless hospitalization. The claim is processed by the hospital subject to approval by your TPA.
"Jupiter Hospital TPA Help Desk" is only helping you to get your claim processed by TPA. In the event of the cashless authorization request being rejected by TPA, the patient has to pay the bill to the hospital, and try to claim the expenses subsequently from the Insurance company or TPA.
Cashless Process at Jupiter Hospital
In the case of a planned admission, you would have first consulted a doctor who in turn would have advised you on the probable date of hospitalization. In such a case, you must apply for an approval of the estimated hospital expenses with your TPA at least 4-5 days prior to the date of hospitalization. Our TPA Help Desk will assist you with the pre-authorization procedure. However, you will need to bear in mind that the TPA Help Desk is only a facilitator and can in no way influence the decision on the approval. Approval/denial of cashless facility is the decision of the TPA, depending on your policy terms and conditions.