Insurance & Claims Policy

Sree Krishna Nursing Home (SKNH)

At Sree Krishna Nursing Home (SKNH), we are committed to providing accessible, transparent, and affordable healthcare services. To support patients covered under health insurance schemes, we have established a structured insurance and claims policy that ensures a smooth and hassle-free process.

This policy outlines the procedures, requirements, and responsibilities related to insurance coverage, cashless treatment, and reimbursement claims.

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1. Acceptance of Insurance Coverage

Sree Krishna Nursing Home accepts a wide range of health insurance policies offered by leading insurance companies and Third-Party Administrators (TPAs).

• We collaborate with major insurance providers to facilitate insurance-based treatments.

• Patients are requested to inform the hospital about their insurance coverage at the time of consultation or admission.

• Early disclosure of insurance details helps ensure timely verification and claim processing.

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2. Pre-Authorization Process

For patients opting for cashless treatment, pre-authorization from the insurance provider is mandatory.

• Pre-authorization is an approval given by the insurance company before treatment begins.

• Patients must submit valid insurance policy details, including policy number and TPA details, at the time of admission.

• The SKNH Insurance & Billing Department will assist patients in initiating and following up on the pre-authorization request.

• Treatment under cashless mode can commence only after approval from the insurer or TPA.

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3. Eligibility for Insurance Claims

To be eligible for insurance claims:

• The patient must hold a valid and active health insurance policy at the time of admission.

• The policy should cover the treatment, procedure, or hospitalization availed at SKNH.

• All claims are subject to the terms and conditions of the insurance policy, including:

  • Waiting periods

  • Policy exclusions

  • Sub-limits

  • Co-payment clauses

The hospital follows the insurer’s guidelines strictly while processing claims.

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4. Cashless Treatment Facility

Cashless treatment is available for patients whose insurance policies are part of SKNH’s network tie-ups.

• Under this facility, eligible treatment expenses are settled directly between the insurance company and the hospital.

• Patients are required to complete the pre-authorization process prior to admission.

• Any non-payable items, co-payments, or excluded expenses must be borne by the patient.

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5. Claim Documentation & Submission

Upon discharge, SKNH will prepare and submit the necessary documents to the insurance provider or TPA.
The documents generally include:

• Copy of valid insurance policy / e-card

• Admission and consent forms

• Medical reports and investigation findings

• Doctor’s prescriptions and treatment records

• Discharge summary

• Final hospital bill with itemized details

• Any additional documents requested by the insurer

Timely and accurate documentation helps avoid delays or rejections.

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6. Reimbursement Claim Process

If cashless treatment is not applicable:

• Patients are required to pay the hospital bill directly at the time of discharge.

• Patients can then apply for reimbursement with their insurance company.

• SKNH will provide all required medical records and billing documents to support the reimbursement claim.

• Reimbursement approval and payment are entirely at the discretion of the insurance provider.

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7. Exclusions in Insurance Coverage

Insurance policies may exclude certain treatments or services. Common exclusions include:

• Cosmetic or aesthetic procedures

• Fertility and infertility treatments

• Non-medical or elective procedures

• Pre-existing diseases (subject to policy terms)

• Treatments not covered under the policy scope

Patients are strongly advised to review their insurance policy carefully to understand applicable exclusions.

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8. Co-Payments and Deductibles

Some insurance policies require the patient to bear a portion of the treatment cost.

• This may be in the form of a co-payment or deductible.

• The amount and percentage are determined by the insurance provider.

• Patients must clear all co-payment or deductible amounts directly with SKNH before discharge.

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9. Claim Rejection or Disputes

In case of claim rejection, partial approval, or disputes:

• SKNH will assist patients by providing necessary clarifications and documentation.

• The hospital will coordinate with the insurance provider or TPA to help resolve the issue.

• Patients may also approach their insurance company’s grievance or customer support department for further resolution.

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10. Insurance & Billing Support

For any queries related to insurance coverage, pre-authorization, cashless treatment, or claims:

Insurance & Billing Department
Sree Krishna Nursing Home, Narayangarh

• Phone: [Insert Contact Number]

• Email: [Insert Email Address]

• In-Person Support: Visit the Billing Department during working hours

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Commitment to Transparency

By following this Insurance & Claims Policy, Sree Krishna Nursing Home ensures a transparent, ethical, and patient-friendly approach to insurance-based healthcare—helping patients focus on recovery without unnecessary financial stress.

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