Insurance & TPA
How health insurance and cashless treatment will work at Goga Ji Hospital.
Cashless and reimbursement
There are two ways health insurance usually pays for hospital treatment. Under cashless treatment, the hospital claims directly from your insurer or their third-party administrator (TPA), and you pay only what your policy does not cover. Under reimbursement, you pay the hospital and then claim the amount back from your insurer yourself.
Cashless is only possible where the hospital is empanelled with that particular insurer or TPA.
Check your insurer with us first
Cashless treatment depends on the hospital being empanelled with your particular insurer or TPA. Before you come in, call us or send an enquiry with your insurer’s name and we will confirm whether cashless applies to you, or whether it would be a reimbursement claim.
How a cashless claim works
For planned admissions. In an emergency, treatment starts first and the claim is raised alongside it.
- 1
Tell us you have insurance
Share your policy or TPA card at the time of admission, along with a photo ID.
- 2
Pre-authorisation is raised
The hospital sends the insurer or TPA the diagnosis, planned treatment and estimated cost, and asks for approval.
- 3
The insurer responds
The insurer approves an amount, asks for more information, or declines. This is their decision, not the hospital's.
- 4
Treatment proceeds
Approved treatment goes ahead. Anything your policy excludes — non-medical items, or amounts above your limit — remains payable by you.
- 5
Settlement at discharge
The approved amount is settled between the hospital and the insurer. You are told clearly what remains payable before you leave.
What to carry
- Insurance policy card or TPA card
- Photo identification for the patient and the primary policy holder
- Policy number and, if it is a corporate policy, employee details
- Any pre-authorisation letter already issued by the insurer
- Previous prescriptions and reports relating to the condition
Two things worth knowing in advance
- Most policies have a waiting period for pre-existing conditions, and exclude some treatments entirely. Check your own policy document.
- Approval decisions are made by your insurer. The hospital submits the claim and shares whatever the insurer asks for, but cannot overturn a refusal.
Checking whether your cover applies?
Send us your insurer or TPA details before you come in and we will tell you what to bring.