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SKNH Insurance and Claims Policy

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At Sree Krishna Nursing Home (SKNH), we aim to make healthcare accessible and affordable for all our patients. Our insurance and claims policy ensures a smooth process for patients covered by health insurance plans. Below is a detailed guide to our insurance and claims policy:

1. Insurance Coverage Acceptance:

• SKNH accepts a variety of insurance providers and health plans.

• We collaborate with major health insurance companies and Third-Party Administrators (TPAs) to ensure your treatments are covered.

• Patients must inform us about their insurance provider at the time of admission or consultation.

2. Pre-authorization Requirements:

• For cashless services, pre-authorization is required before availing medical treatment.

• The pre-authorization process ensures that your insurance provider approves the claim.

• Patients must provide insurance policy details at the time of admission.

• SKNH's billing and insurance team will assist in initiating the pre-authorization process.

3. Eligibility for Insurance Claims:

• To be eligible for insurance claims, patients must have a valid insurance policy at the time of admission.

• The policy must cover the medical services rendered at SKNH, including hospitalization, surgeries, and diagnostic services.

• The insurance company’s terms and conditions, such as exclusions, co-payments, and waiting periods, will be followed.

4. Cashless Facility:

• Cashless services are available for patients whose insurance policies are part of the tie-up network with SKNH.

• Patients can avail of cashless treatment directly at SKNH, with the insurance company settling the eligible amount directly with the hospital.

• For cashless services, patients must complete the pre-authorization process before admission.

5. Claim Submission Process:

• Upon discharge, SKNH will prepare and submit the claim documents to your insurance provider.

• The following documents will be required for claim submission:

  • Copy of the insurance policy.

  • Admission form.

  • Medical reports (diagnosis, treatment details, prescriptions).

  • Discharge summary.

  • Billing statement.

  • Any other documents required by the insurance provider.

6. Claim Reimbursement Process:

• In cases where cashless treatment is not applicable, patients can pay the bill directly and then file for reimbursement with their insurance provider.

• Reimbursement claims should be submitted along with all relevant documents to the insurance company.

• SKNH will provide all the necessary documents to support the reimbursement claim.

7. Exclusions in Insurance Coverage:

• Certain treatments, procedures, and services may not be covered under the insurance policy.

• Common exclusions may include cosmetic surgeries, fertility treatments, and treatments for pre-existing conditions (if applicable as per policy).

• Patients are advised to review their insurance policy’s terms to understand these exclusions better.

8. Co-payments and Deductibles:

• Some insurance policies may require patients to pay a portion of the treatment cost, either as a co-payment or deductible.

• The insurance company will specify the co-payment amount in the policy.

• Patients are required to settle any co-payment or deductible amount directly with SKNH at the time of discharge.

9. Disputes and Claim Rejection:

• In case of a claim dispute or rejection, SKNH will assist the patient in providing all necessary documentation and clarification.

• The hospital will collaborate with the patient and the insurance provider to resolve any issues related to the claim.

• Patients may also reach out to their insurance provider’s grievance redressal mechanism for further assistance.

10. Contact Information for Insurance Queries:

• For any inquiries regarding insurance coverage, pre-authorization, or claims process, patients can contact the SKNH Insurance and Billing Department.

  • Phone: [Insert Contact Number]

  • Email: [Insert Email Address]

  • In-person: Visit the SKNH billing department for assistance during working hours.

By following the insurance and claims policy, SKNH ensures a seamless and transparent process for its patients, making it easier to access the best possible healthcare without unnecessary financial burden.