Medical Insurance TTK

Less Awareness and laziness is a common attribute of a software engineer. Mostly we do not know few IMPORTANT things around us which we are supposed to know. We always what is the next best thing in technologies but sadly not other stuffs. We do not know where our money is flowing, what are our investments, what exactly are the clauses, benefits etc.

As a result of some clean up activity, for the first time in 5 years, I decided to know my policies and TTK Health Card is one among them.. This made me understand few things and raised a lot of questions that i need to ask my company.

So here is what I could understand and summarize. Hope it will help one or two readers with respect to information and motivate few others to start reading. Please do contribute to this article if you have gone through some experiences.

TTK Health Card basically allows us "Cashless Hospitalization" in Network Hospitals (only). In simple words we need not have the cash in hand. For non network hospitals, we need to submit the bills and then claim (that is we need to have cash).

One basically need to know/have mainly the Policy Number, TTK Card, Amount Limit, list of diseases, What documents, Network Hospital, Contact numbers and Process. Here it goes

FlowChart



Planned hospitalization
Authorization letter to be filled by doctor.
if date/doctor/hospital/disease is changed, a new letter need to be submitted

Emergency
Fill the complete form and then send to TTK office. TTK will send back within 6 hrs of request.

Non Network Hospitals
Sign a claim form filled in all respect and give it to hospital along with other authorization letter given by TTK before the discharge

Diseases covered
{NEED TO GET THIS DETAILS}

Documents required initially
TTK identity card,
Photo Proof
Auth letter

Hospital Bill with receipt of payment along with break up signed by member
surgeon/consultant bills (stamped numbered receipt)
Prescription and medicine bill
Discharge Summary sheet from hospital
Pathological and other investigation reports along with doctors authorization

What TTK does not cover
deposit towards non medical expense
registration fees/admission fees
telephone, ambulance expenses not covered.
hospital room
operation theater charges
diagnostic tests
medicine cost
blood transfusions,
oxygen cylinders
pacemakers, artificial lambs

TTK offices: Contact Details
TTK HO BANGALORE 1800 425 8885
TTK HO BANGALORE 1800 425 7878
TTK HO BANGALORE 1800 102 1234
Toll free fax num:18004252626
Address:no 4 crimson court 11 jeevan bhimanagar main road HAL stage
bangalore 560075 phone num:4125 5794 fax 080 4215 5797
Email: care@ttkhealthcareservices.com

Rejections
It can be rejected, if sufficient amount is not there. if disease is not covered and document
provided is not proper

Note:

• Denial of pre-authorization letter shall not be construed to mean that the policy holder cannot claim under the terms and conditions of the policy from TTK.In such cases One can file your claim for reimbursement and TTK will settle the claim as per your policy terms and conditions
• Retain a copy of final bill and discharge summary
• In case the Health card is not yet issued, please contact our Toll Free No. and keep with you the policy no. at all times.
• Its better one knows the TTK card no or policy number
• It is better one knows the limit
• It is better one knows the diseases too
• One need to know the exacting wording of the policy issued by your insurance company (please check)

Network Hospital
This is a huge List. It can be got from the web site or toll free number

Pre and Post hospitalization expenses
Pre and Post hospitalization expenses can also be claimed. (just before admit and after the discharge with certain number of days). A limit is there for this also. Send a copy of discharge summary, auth letter, original bills. TTK will settle with the limit of overall limit. The bills must be sent within 7 days from completion of treatment


FLOWCHART EXPLAINED IN WORDS

CLAIM REIMBURSEMENT

Some of the requirements to be complied with in the event of a claim are listed below:

• Step 1: Please immediately intimate TTK Healthcare Services about the claim. Claim intimation can be done by the following methods

  Inform the Call Centre at Toll Free No: 1800 425 8885 / 425 7878
  And intimate the claim to care@ttkhealthcareservices.com

• Step 2: At the time of intimation, the customer should provide the following

  a. TTK ID card No. or Policy Number
  b. Date of Hospitalization
  c. Ailment
  d. Approximate Date of Discharge
  e. Approximate Date of Claim submission.
  

• Step 3: Download the Claim Form & Medical Certificate Form from our website and fill all columns. The Medical Certificate Form will be filled by the treating doctor.
  
  
• Step 4: Send the filled and signed Claim and Medical Certificate Forms to closest TTK office by courier / hand delivery, along with the following papers

Original Discharge Summary; All the Original Bills with break up. All Original Diagnostic Test Reports performed on patient during hospitalization; Policy copy (if available) All Medical Bills must accompany the

Step 5: TTK will assess the validity of the claim based on the documents submitted, validate the policy,
validate the treatment undergone and settle the claim within the claim settlement parameters. In case of
claim is not adhering with parameters, the case would be rejected.

Step 6: TTK will correspond with you within 7 days of Claim receipt -

If Claim settled, Discharge Voucher will be sent If Document Shortfall, request for the shortfall documents If Claim rejected, Rejection Letter will be sent

Step 7:

• Event of Settlement: Please sign the Discharge Voucher and send it back to local TTK office
• Event of Shortfall: Please forward the requested documents for settlement of claim to local TTK office.
  
• Event of Rejection: If you want us to re-open the case, please forward the request supported by valid documents. We will process the same after clarification from the Insurance Company.
  
• Event of Disallowance: Please forward the necessary documentation not submitted before to process disallowance and for addendum settlement

Action Items
Need to get the list of diseases
list of items not covered
The wordings in the policies
the amount limit
few known network hospitals around