Quick Answer
To get pre-authorization for surgery insurance in India, submit your surgeon's advice, hospital estimate, investigation reports, and policy details to the hospital insurance desk 3 to 5 days before planned surgery. Approval typically takes 4 to 8 hours.
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Getting insurance pre-authorization right is the difference between a fully cashless surgery and a large out-of-pocket bill. Here is everything you need to know.
What Is Pre-Authorization?
Pre-authorization (also called pre-auth or prior approval) is the process of getting written approval from your insurance company before a planned surgery. The insurer reviews the medical necessity and confirms how much they will pay. Without pre-auth you may have to pay upfront and file a reimbursement claim later.
Step-by-Step Guide to Getting Pre-Authorization
Step 1 — Verify your policy coverage. Before anything else check that your surgery is covered under your policy, the waiting period has been completed, your sum insured is adequate, the hospital is on your insurer's network, and there are no relevant exclusions. MySurgery insurance team does this free check within 30 minutes.
Step 2 — Choose a network hospital. Only network hospitals can process cashless pre-auth. Go to your insurer's website or app and search for empanelled hospitals in your city. MySurgery partner hospitals are on the network of all major insurers.
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Step 3 — Collect the required documents. Surgeon's advice letter recommending surgery. Relevant investigation reports (blood tests, imaging, biopsy). Doctor's prescription. Completed pre-authorization form (available at hospital insurance desk). Your health insurance card and policy number. Government ID proof. If pre-existing condition: previous treatment records.
Step 4 — Submit to hospital insurance desk. Go to the hospital's insurance desk or TPA (Third Party Administrator) desk and submit all documents. Hospital insurance coordinators fill in the claim form and send to the insurer. Most hospitals do this electronically. MySurgery coordinators are present with patients at this step.
Step 5 — Insurer reviews and approves. For planned surgeries the insurer typically approves within 4 to 8 hours. For complex cases (organ transplant, cancer surgery, high-value claims) approval may take 24 to 48 hours. The insurer may ask for additional documents — respond quickly to avoid delays.
Step 6 — Receive approval letter. You get a written approval (cashless authorisation letter) specifying the approved amount, procedure, hospital, and validity period. Review it carefully. If the approved amount is lower than expected, MySurgery helps file a query or escalation.
Common Reasons for Pre-Auth Rejection and How to Avoid Them
Waiting period not completed: Most common reason. Solution — check your policy date carefully before scheduling surgery. Procedure not covered: Some surgeries are excluded. Solution — verify with MySurgery before booking. Inadequate documentation: Incomplete surgeon's advice or investigation reports. Solution — ensure all documents are complete before submission. Pre-existing condition not declared: If the insurer finds undisclosed pre-existing conditions, claims can be denied. Always disclose fully at policy inception. Room rent issue: Choosing a room above your entitled category. Solution — select appropriate room category.
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Emergency Surgery Pre-Authorization
For emergency surgery you do not need to wait for pre-auth. Get treated immediately and inform the insurer within 24 hours. Submit documents within 48 to 72 hours. Emergency pre-auth is approved retrospectively.
Call MySurgery at 8588967050 for free pre-authorization assistance. Our insurance team handles the entire process so you can focus on recovery.
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