How to reply to a pre-auth query

A pre-auth query is a request for one more piece of information, not a rejection. Read exactly what is asked, answer only that, and send it the same day with the document attached — usually a treating-doctor letter on the hospital letterhead, earlier prescriptions, an investigation report or a cost break-up. Keep the query number in the subject line. Unanswered queries are the most common reason a cashless request lapses into a denial.

Step by step

1. Read the query line by line

   Note the query number and each item asked for. Most queries ask for one to three things.

2. Collect exactly those documents

   Do not send the whole file again. Attach only what answers the query, named clearly (for example: "Q1 – first consultation 12-03-2026.pdf").

3. Get the treating doctor’s letter where needed

   On letterhead, signed with registration number: duration of the illness, date of first diagnosis, why admission (or ICU) is necessary, and why the treatment cannot be done as OPD or day care.

4. Reply the same day

   On the provider portal against the same request, or by email to the pre-auth ID with the query number in the subject. The decision is due within one hour of a complete request under IRDAI’s 2024 master circular.

5. Follow up in writing

   If there is no decision, write again quoting the query number and time of your reply. Keep screenshots of portal submissions.

6. If cashless is denied

   Ask for the denial reason in writing, tell the patient they can pay and claim reimbursement, and keep the full file — the denial is often reversed when the complete hospital record is seen.

Common queries and what to send

• Duration of illness / date of first consultation → treating doctor’s letter with dates, earlier prescriptions
• Past history or pre-existing disease → old prescriptions and reports, or a doctor’s letter that there is none
• Justify admission or "can be done in OPD / day care" → doctor’s letter on why inpatient care is needed, with vitals and reports
• Justify ICU stay → ICU notes, vitals, doctor’s letter on criteria for ICU
• Cost break-up / reduce estimate → estimate by head, room category, package rate if applicable
• Implant details → implant type, invoice and sticker at discharge
• Accident cases → MLC / FIR copy, or a note on why none was made; alcohol test if asked
• Sum insured / balance → policy schedule and earlier claims this year

Reply format

Subject: Reply to query no. [ ] — pre-auth no. [ ] — [patient name], policy no. [ ].

With reference to your query dated [date/time], please find the reply: Q1 [question] — [one-line answer], document attached: [name]. Q2 [question] — [answer], document attached: [name].

All documents asked for are attached. Please process the cashless request. [Name], Insurance desk, [Hospital], [phone].

When the claim is paid short or not at all

If a cashless claim is approved and then not paid, paid short after deductions, or rejected after discharge, the hospital can recover it through a written escalation with the TPA and the insurer. Medilock’s Cashless Recovery desk does this for hospitals and is paid only on what is recovered.

Related guides

• How to fill a pre-auth form
• Cashless claim rejected — for hospitals
• Get a rejected claim reconsidered
• Claim short-paid or deducted
• All rejected-claim guides

Is a pre-auth query the same as rejection?

No. A query asks for more information. Answer it the same day and the request is decided; leave it and it can lapse into a denial.

How quickly should we reply to a pre-auth query?

The same day — ideally within the hour. The insurer’s one-hour decision clock under IRDAI’s 2024 master circular runs on a complete request.

What if the TPA keeps raising the same query?

Reply in writing quoting the earlier reply and its time, attach the document again, and escalate to the insurer’s provider desk or grievance officer if it continues.

Can the patient still claim if cashless is denied?

Yes. The patient can pay the hospital and file a reimbursement claim within the policy time limit. A rejection can then be reconsidered through the grievance officer, Bima Bharosa and the Ombudsman.

प्री-ऑथ क्वेरी का जवाब कैसे दें?

जो पूछा गया है सिर्फ़ उसी का जवाब दें, उसी दिन, ज़रूरी दस्तावेज़ और डॉक्टर के पत्र के साथ — सब्जेक्ट में क्वेरी नंबर लिखें।