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Frequently Asked Questions For Insured Life

Who is pentacare medical services?

Pentacare is a TPA ( Third party Administrator) specializing in health insurance services to manage claims in a very effective and efficient manner.

 

Is Pentacare an Insurance company?

No, we are a TPA which works in alliance with Insurance companies and other payers as an administrative support for claims management.

 

What role does Pentacare (TPA) play?

We deal in providing complete Health Insurance management and Third Party Administration services to Insurers and other Payers of Healthcare.

 

How do I use my health insurance card?

You need to present your Pentacare Health Insurance card every time you visit a health services provider (hospital/clinic / Pharmacy) within the network assigned before availing any services in order to qualify for direct billing.

 

What is direct billing?

You show your card to the provider listed in your network and only pay the deductible written on the card along with co payment (if applicable) for availing the medical services without paying for full cost out of your pocket.

 

What is co-payment (co –pay)?

It is a portion of medical expenses incurred, usually a fixed percentage written on the card itself, which you have to pay out of your own pocket.

 

Can I visit a non network provider?

Yes you can, however it would not be on direct billing. You have to pay for the services  in full and file a reimbursement claim for eligible expenses. Also,Check your insurance policy  if it allows for reimbursement in a non- network provider.

 

How is a pre existing condition defined?

Any Beneficiary health condition known to the Beneficiary and/or to the Contractholder that exhibited symptoms or was a consequence of Injury or Illness for which medical, Surgical and/or pharmaceutical Treatment, medical diagnosis or other advice was provided prior to the Beneficiary’s Enrollment Date.

 

How do I apply for reimbursement claim?

You have to fill the reimbursement form which is signed and stamped by your physician and you.

 

How do I get the reimbursement form?

You can contact your HR or you can download it from our website

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