The Anyuta TPA in Healthcare Private Limited (ATPAPL) is a Third Party Administrator in Healthcare (IRDA License No 017) providing Healthcare through its networked Hospitals, Nursing homes, Diagnostic Centers, Clinics, and Doctors and other Healthcare providers across the country to the insured and Non – insured people.
We aim at making, quality Healthcare Affordable and Available to every Indian. Affordability is made possible by Risk pooling, Standardizing the Medical Documentation and Accounting System along with Transparency. The Availability is made possible by integrating the Public and Private Sector Healthcare Delivery System.
Our investment in the Research and Development in the field of Healthcare Financing, Delivery System, Documentation and Accounting, resulted in a win – win situation for the Healthcare Financiers, Healthcare Provider Network and the Policyholders.
For the R&D work, we selected one Public Sector Company, The National Insurance Company Limited (NIC), one healthcare Product, Universal Health Insurance Scheme (UHIS), dedicated Network of Hospitals and a group of dedicated doctors, practicing ethical medicine. This resulted in a Health care System, with inbuilt checks and balances, creating a marginal surplus to all the stakeholders and giving the best of healthcare to the Policyholder.
Health Card is to identify you as the beneficiary of the Health Insurance and to give access to our Hospital network willing to provide Cashless Services. Secure your ID card and carry it with you at all times. Quote your Anyuta ID Card No. when you call our Helpline.
APAIHPL Healthcare provider network consists of reputed Doctors, Nurses, Paramedics, Hospitals, Nursing Homes, Daycare Centers, Group practices, Dentists etc., across India.
Please remember that the Insurance money is nothing but your money. You have paid the premium and the premium will go up based on its usage, hence use it carefully. Do not get admitted to a hospital if it be treated on outpatient basis. Consult with your Family Physician, understand the benefits of Conservative line of Management over the Surgical Intervention, advantage of Home Care over Hospitalized Care and take an Informed Healthcare decision. In case of doubt Anyuta Trust members can call us for help.
Once you are admitted in a Hospital, check on every aspect of the Hospitalized care you receive, need for it and the costs. The drugs that you buy and consume should match with the Doctor’s Prescription. Check the rates in the Bill and the expiry date of the Medicine in the package. Always sign on the backside of the Prescriptions, Bills and the Discharge Summery.
We advise you to pay the Bills upfront wherever possible, subsequently submit the Original Claim File. This will help in cutting health care costs for you and the insurer.
The cashless access in ATPAIHPL network of hospitals is merely a facility extended to you by the TPA under contract with your insurer. The Anyuta TPA does not guarantee the availability, quality and outcome of the treatment. Selection of a network or a non-network hospital is a prerogative of the beneficiary and is responsible for the outcome.
The admitting hospital should send Anyuta TPA, a Pre-Authorization request, to avail Cashless Facility. Hence please see that the Hospital sends a Pre-Authorization request to ATPAIHPL, indicating your admission for treatment as soon as possible.
The Physician ordering your admission will have to fill in the following information in the Anyuta Pre-Authorization Form,
After due scrutiny of the Pre-Authorization Request, we will promptly respond. Our response is in three forms, Accepted, Accepted with Co – Payment clause, Denied.
If accepted, hospital will get an Authorization Letter (AL) along with the Check List for Cashless treatment and guarantee of payment as per the policy guidelines. In case of emergency, hospital should start the treatment without waiting for the TPA formalities.
File all the Original Bills, Discharge Summary, Investigation reports etc. as listed in the Check List, pertaining to your treatment. Send this file with a covering letter and the list of enclosed documents to Anyuta TPA. The Cashless service or Reimbursement of the Claim amount is subject to the terms, conditions, exclusions and limitations of your Health Coverage Plan.
In case of Planned Admission, register your name with the hospital well in advance.
Charges for the certain facilities are not covered by majority of Health Plan; few of them are as under:
Cost of such services is paid by the patients directly to the Hospital.
A. In case sufficient information in the prescribed format is not given.
B. In case of ATPAIHPL medical team is not convinced of the eligibility under the coverage, pre-authorization for cashless can be denied.
Since a large percentage of the Hospitalizations are planned, obtain your Authorization Letter in advance.
Some Insurance Policies, do not cover pre-existing diseases & complications of chronic conditions, you are advised to give all required information to the Medical Team of ATPAIHPL to verify the eligibility well in advance in case of planned surgery.
Denial does not in any way prevent you from seeking necessary medical attention for hospitalization. In such cases you are advised to file your claim for reimbursement and ATPAIHPL will settle the claim as per eligibility and policy guidelines.
Request the Hospital to issue a certificate in the name of the insurer, signed by the admitting Doctor stating that
The file should contain the following list of documents with a covering letter,
The Claim Form is available with the Insurer or you can download it from www.anyuta.co Retain a certified copy of all the documents submitted to ATPAIHPL
Medical expenses incurred after discharge from the Hospital will be reimbursed as per your Health Coverage Plan by the insurer. Prescriptions and bills/receipt of such services should be submitted to ATPAIHPL along with Insurance claim form duly signed by you.
Intimate ATPAIHPL by way of E –mail or letter before getting admitted is a must even in a Non - Network Hospital. In case you choose to get treated in a Non – Network Hospital, ask them to sign the MOU with ATPAIHPL and provide Cashless facility to you, or else you will have to pay the cost of your treatment in the first place and ask for reimbursement. To get the best treatment, call us our Doctors they will help you.
For speedy Claim settlement there should not be any scope for Moral Hazard. Kindly insist on a stamped, preferably numbered Bills and Receipts from the Doctors. Insist on Bills for every service that you have availed in the Hospital including the Doctors Consultation / Procedural Fee. Organize your Receipts and Bills for convenience of accounting and payment.