1 If there is any doubt in the coverage of treatment of present ailment under the Policy

2 If the information sent to TPA is insufficient to confirm coverage

3 If the ailment/condition is not being covered under the policy

4 If the request for pre-authorization is not received by TPA in time

In such a situation, the Insured can take the treatment, pay for the treatment to the hospital and after discharge, send the claim to TPA for processing.