PLANNED ADMISSION Sample Clauses
The Planned Admission clause defines the procedures and requirements for hospital admissions that are scheduled in advance, rather than those arising from emergencies. Typically, this clause outlines the need for prior authorization from the insurer or healthcare provider, specifies any necessary documentation, and may set timeframes for notification before the admission occurs. Its core function is to ensure that all parties are informed and prepared for the admission, helping to manage costs, coordinate care, and prevent disputes over coverage or payment.
PLANNED ADMISSION. It is agreed between the parties that on receipt of request for hospitalization on behalf of the beneficiary the process to be followed by the hospital is prescribed in Annexure I.
PLANNED ADMISSION. 4.1 Request for hospitalisation on behalf of the benefic iary may be made by the hospital provider / consultant attached to the provider /benefic iary himself after obtaining due details form treating doctor in the prescribed format as per the Annexure-A. The prescribed format needs to be faxed to the 24 hr help desk at ▇▇▇▇▇ ▇▇▇▇▇▇▇ telephone number /contact details of treating physic ian and the benefic iary needs to be mentioned as it would ease the process in the cases where the symptoms are vague, no effective diagnosis is arrived at, the medic al team of ▇▇▇▇▇ ▇▇▇▇▇▇▇ would get in touch with treating physic ian /benefic iary if necessary.
4.2 ▇▇▇▇▇ ▇▇▇▇▇▇▇ guarantees payment only after receipt of intimation and the necessary medic al details and after it has ascertained the eligibility of coverage and issued the Preauthorisation.
4.3 In case the ailment is not covered or given medic al data is not suffic ient for the medic al team of helpdesk to confirm the eligibility, ▇▇▇▇▇ ▇▇▇▇▇▇▇ can deny the guarantee of payment whic h shall be addressed to the Insured. The provider will have to follow their normal practic e in such case.
4.4 Denial of Authorisation/guarantee of payment in no way means denial of treatment. The provider is requested to deal with each case as per their normal rules and regulations.
4.5 Authorisation certificate will mention the amount guaranteed class of admission, eligibility of benefic iary or various sub limits for rooms & board, surgical fees etc. wherever applicable. As per the benefit plan of the insured. Provider must see that these rules are strictly followed.
4.6 The guarantee of payment is given only for the necessary treatment cost of the ailment covered and mentioned in the request for hospitalisation. Non covered item like Telephone usage, relative food, hospital registration fees etc. must be collected directly from the insured Any Investigation carried out at the request of the patient but not forming the necessary part of the treatment also must be collected from the patient.
4.7 The Authorisation certificate normally mentions the amount whic h is requested at the time of request for hospitalisation or the total sum available. Therefore, in event of cost of treatment going above the guaranteed amount the provider may check the availability of further limit with ▇▇▇▇▇ ▇▇▇▇▇▇▇.
4.8 Primary responsibility of obtaining Authorisation letter would be of the policyholder and Hospitals/Provider could only assist if require...
PLANNED ADMISSION. 4.1 Request for hospitalization on behalf of the beneficiary may be forwarded by the provider/consultant attached to the provider, or beneficiary himself after obtaining due details from the treating doctor in the prescribed format i.e. “Request For Authorisation Letter” (RAL). The RAL needs to be faxed to the 24-hour Authorisation /Cashless Department at MDIndia Healthcare Services (P) Ltd. Head Office, Pune Telephone number/ contact details of treating physician and the beneficiary needs to be mentioned, as it would ease the process. The medical team of MDIndia would get in touch with treating physician / beneficiary, if necessary.
PLANNED ADMISSION i. Request for admission on behalf of the Member may be made by the Service Provider or Consultant attached to the Service Provider as per the prescribed format. The Pre- Authorization form needs to give the details of the Member's proposed admission along with the necessary medical details and the treatment planned to be administered and the breakup of the estimated cost in accordance with Schedule I, attached herein.
PLANNED ADMISSION. 4.1 The beneficiary of the NIT, Jalandhar will be allowed admission only after obtaining the referral slip from the institute except in case of emergency in which the confirmation/authorization of the patient has to be obtained by the provider within three days or prior to discharge whichever is earlier. In case of Drink and Drug abuse reimbursement will not be allowed.