• Request for hospitalization shall be forwarded by the provider immediately after obtaining due details from the treating doctor in the preauthorization form i.e. request for authorization letter (RAL).
• The RAL shall be sent electronically along with all relevant details in the electronic form to the 24 hour authorization/cashless department of the insurer or of its representative. TPA's medical team may consult the treating physician and the insured.
• The insurer's or its representative TPA's medical team may consult the treating physician or the insured, if necessary.
• If the treating physician of the provider identifies any disease or ailment as pre-existing, the treating physician shall record it and also inform the insured immediately.
• In the case where the symptoms appear vague/no effective diagnosis is arrived at, the medical team of the insurer or its representative TPA may consult with treating physician/insured if necessary.

The following documents shall be included by the patient in the list of documents to be sent along with the claim form to the insurer or its representative TPA.

• Original pre-authorization request form
• Copy of authorization letter
• Original investigation report
• All original prescription & pharmacy receipt etc. where the insured requires the discharged card/reports or other relevant medical documents.

In case of Emergencies, the procedures are as follow:

• Request for hospitalization shall be forwarded by the provider immediately after obtaining due details from the treating doctor in the preauthorization form i.e. request for authorization letter (RAL)
• The RAL shall be sent electronically along with all relevant details in the electronic form to the 24 hour authorization/cashless department of the insurer or of its representative. TPA's medical team may consult the treating physician and the insured.
• The insurer's or its representative TPA's medical team may consult the treating physician or the insured, if necessary.
• If the treating physician of the provider identifies any disease or ailment as pre-existing the treating physician shall record it and also informed the insured immediately
• If the treating physician of the provider identifies any disease or ailment as pre-existing, the treating physician shall record it and also inform the insured immediately.
• In the case where the symptoms appear vague/no effective diagnosis is arrived at, the medical team of the insurer or its representative TPA may consult with treating physician/insured if necessary.
• However, any life saving, limb saving, sight saving, and emergency medical attention cannot be withheld or delayed for the purpose of waiting for authorization.
• Provider – in the meanwhile - may consider treating him by taking a token of deposit or so, as per their norm.
• Once authorization is issued after ascertaining the coverage, the provider shall refund the deposit amount to the insured.