If you’ve ever tried to use insurance to pay for a medical procedure—or a prosthetic device like a bionic hand—you’ve probably heard the word pre-authorisation. It sounds simple. But for many people, this is the step that causes the most delays, confusion, and frustration in the whole process.
Whether you are using CGHS, ECHS, ESIC, Ayushman Bharat, or private health insurance, pre-authorisation is the first and most critical step in getting cashless approval. Without it, your treatment or prosthetic fitting won’t be approved. And without approval, there’s no coverage.
At Robobionics, we help patients and families go through this step every single day. And what we’ve seen is this: most pre-authorisation delays happen not because the system is broken—but because people don’t know how to prepare, submit, and follow up correctly.
This article is here to fix that.
We’ll explain what pre-authorisation actually means, how long it takes under different schemes, what documents you need, and most importantly—how to speed it up.
If you want to avoid stress, save time, and make sure your prosthetic or surgery gets covered without last-minute drama, read on.
What Is Pre-Authorisation?
The First Step Before Cashless Approval
Pre-authorisation is the process where your insurance provider gives advance approval for a treatment, surgery, or device like a prosthetic.
Before the hospital or prosthetic clinic can move forward with the procedure or fitting, they must get this green signal.
Think of it as a permission slip from the insurer.
It tells the hospital, “Yes, we agree to cover this under the patient’s policy.”
Why It Matters So Much
Without pre-authorisation, even if your policy covers prosthetics or medical devices, the treatment won’t move forward as a cashless case.
This means you might have to pay out of pocket first and then apply for reimbursement—which can take weeks or months.
Pre-authorisation helps avoid this.
Once approved, your treatment or device cost is directly settled between the hospital or vendor and the insurance company.
You don’t have to worry about large upfront payments.
That’s why speeding up this process is so important—especially when the treatment is urgent or life-changing.
Who Gives the Pre-Authorisation?
The Role of TPAs and Insurance Cells
If you’re using private health insurance, the pre-authorisation request is sent to a TPA—a Third-Party Administrator.
They act as the middleman between the hospital and your insurer.
They check:
- Your policy terms
- Eligibility for the treatment
- Supporting documents
- Package pricing
Once they review and approve it, your hospital gets a confirmation to proceed.
If you’re using a government scheme like CGHS, ECHS, or ESIC, the request goes to the respective government medical board or scheme officer.
Each scheme has its own approval process, and timelines vary based on urgency, city, and paperwork.
At Robobionics, we’ve worked with all major schemes and know how each one handles pre-authorisations.
How Long Does Pre-Authorisation Usually Take?
For Private Insurance
If everything is in order, private insurers typically respond within 6 to 24 hours.
In emergency cases, approval can come within 2 to 4 hours.
However, for elective treatments or non-hospital services like prosthetics, it can take up to 3 days if additional documents are needed.
Delays usually happen when:
- Documents are incomplete
- The medical need is unclear
- The cost is higher than average
- The provider is not empanelled
For CGHS and ECHS
For CGHS beneficiaries, pre-authorisation often takes 3 to 7 working days.
You must submit a doctor’s recommendation, cost estimate, and sometimes visit the CGHS wellness centre for evaluation.
If the device or treatment is above a certain cost, approval is needed from the Additional Director or Medical Officer in-charge.
ECHS approvals are similar but usually move faster in urgent cases, especially through their online module.
Still, 5 to 10 working days is common.
We help fast-track this by making sure all paperwork is correct the first time.
For ESIC and Ayushman Bharat
ESIC works through its own network of dispensaries and hospitals.
If you are referred properly and your medical officer sends the request, approval can come within 2 to 5 days.
For Ayushman Bharat (PM-JAY), empanelled hospitals raise the request through their digital platform.
This is the fastest system. Approvals often happen within 6 to 12 hours—sometimes even faster.
But only if the hospital or clinic is registered with the scheme.
What Documents Are Required for Pre-Authorisation?
The Essentials You Must Prepare
Most pre-authorisation requests require a standard set of documents. Missing even one of these can delay the entire process or get your request rejected outright.
Here’s what you typically need:
- Doctor’s prescription clearly stating the need for treatment or prosthetic.
- Detailed medical reports such as X-rays, MRI, blood tests, or surgical notes.
- Estimate of cost from the hospital or prosthetic provider with itemised pricing.
- Insurance policy copy or card with valid ID details.
- Patient ID proof like Aadhaar, PAN, or government ID.
- Hospital registration form if applicable.
For CGHS, ECHS, and ESIC, you’ll also need:
- Scheme-specific forms and references.
- Your scheme ID or membership number.
- Signature from an authorised doctor or medical board.
At Robobionics, we prepare these packages for every patient. We double-check every form, photo, and estimate before submission. This alone saves days.
The Importance of Medical Language
One of the most common causes of delay is unclear or informal language in the prescription.
For example, a doctor writing “Patient wants a prosthetic hand” may lead to rejection. It sounds like a choice.
Instead, if the prescription says, “Patient requires a below-elbow myoelectric prosthetic device to regain hand functionality following traumatic amputation,” it’s taken more seriously.
We help your doctor write the correct phrasing that matches insurance standards.
What Slows Down the Pre-Authorisation Process?
Incomplete Information
This is the number one reason for delay.
If the estimate doesn’t show item-wise costs, or if your documents are unclear, the insurer will raise a query. Every query adds at least one to two more days.
That’s why we insist on complete, readable, and verified paperwork before any submission.
Treatment Not in the Standard Package
Many insurers and schemes work with pre-approved treatment packages.
If your prosthetic or surgery doesn’t fit into a common code, the insurer may flag it as non-standard.
In such cases, they ask for extra justification, costing sheets, and sometimes even negotiation.
We often provide cost comparisons, technical breakdowns, and model justification sheets to speed this up.
Lack of Empanelment
This is another common roadblock.
If your prosthetic provider or hospital is not empanelled with the insurance company or government scheme, your pre-authorisation may be rejected or switched to reimbursement.
We always advise checking empanelment first.
If you still want to proceed with a non-empanelled provider, we help you shift from cashless to reimbursement mode quickly—without delaying your treatment.
How to Speed Up Pre-Authorisation (Even Without Contacts)
Be Thorough the First Time
Double-check every field, every document, and every medical note before submission.
Insurers often work on tight timelines. If you get it right in the first go, approval can come in hours—not days.
At Robobionics, we use a pre-submission checklist that reduces back-and-forth almost completely.
Use Digital Submission When Possible
Most insurers and schemes now accept online forms.
CGHS and ECHS have portals for uploading scans and tracking claim status.
Private TPAs also use apps or dashboards where your hospital can upload documents directly.
We help patients submit files digitally, track responses, and even follow up if timelines are crossed.
This is faster than sending physical files or waiting for courier updates.
Follow Up Tactfully
If you haven’t received a response within 24–48 hours, ask your hospital or provider to follow up.
Be polite but clear.
Ask:
- Has the insurer raised any queries?
- Do they need more documents?
- Is the treatment within the policy terms?
- Is approval expected today?
If you’re working with us, we make those calls for you. We escalate when needed, so your case doesn’t get stuck.
Real-Life Scenarios and Timelines
Case 1: Grippy™ Hand Under Private Insurance
Ritika, a 29-year-old marketing executive from Pune, lost her hand in a bike accident. Her employer had provided a corporate health insurance policy.
We worked with her insurer through a TPA to get pre-authorisation for the Grippy™ Bionic Hand.
Her doctor provided a strong recommendation. We attached full documentation and cost justification.
Timeline:
- Day 1: Submission at 10 AM
- Day 2: TPA requested clarification at 11 AM
- Day 2: Clarification submitted by 2 PM
- Day 3: Pre-authorisation approved by 9 AM
She got full cashless approval in under 48 hours—because her documents were clear and complete.
Case 2: CGHS Pensioner Requesting a Mechanical Leg
Mr. Sharma, a 64-year-old retired railway employee, needed a mechanical below-knee prosthetic leg. He was registered under CGHS in Delhi.
He visited the CGHS wellness centre, got a prescription from an approved specialist, and approached us with an estimate.
We prepared a detailed file with photos, doctor’s note, and cost breakup.
Timeline:
- Day 1: Documents submitted at CGHS office
- Day 3: Medical board meeting scheduled
- Day 6: Pre-approval granted
- Day 8: Prosthetic fitting completed
In this case, the government timeline was 6 working days, but proactive document prep cut delays.
Case 3: Emergency Approval via Ayushman Bharat
Naveen, a 19-year-old from a village in Rajasthan, was eligible under PM-JAY. After a farm accident, he needed amputation and a temporary prosthetic for mobility.
The hospital was empanelled under Ayushman Bharat and filed the request digitally.
Timeline:
- Day 1: Admission and submission by hospital
- Day 1: Approval granted in 3 hours
- Day 2: Surgery completed
- Day 3: Temporary prosthetic fitted as part of rehab
The speed here came from two things—emergency categorisation and digital filing.
We later helped the family apply for a permanent Grippy Mech Hand under a private CSR program.
What to Do If Pre-Authorisation Is Delayed
Don’t Wait Without Asking
If your pre-authorisation has been pending for more than 2 days (48 hours), you have every right to ask for a status update.
Delays usually mean:
- The insurer or TPA has asked for extra documents.
- Your hospital missed something in the submission.
- There’s confusion over policy terms or costs.
We’ve seen cases where one missing line on a form caused a 5-day delay. Always double-check or call for an update.
Request Escalation Through the Right Channel
Every insurer and TPA has an escalation matrix.
You can escalate through:
- The hospital’s insurance desk
- The TPA’s helpline
- An email to the grievance redressal officer
- The official health scheme coordinator (in CGHS, ECHS, etc.)
Keep your request polite, factual, and firm.
At Robobionics, we make escalation calls and emails on your behalf when needed.
Shift to Reimbursement Mode If Time Is Critical
If your prosthetic fitting is urgent—say you’re starting work again soon, or facing mobility issues—you don’t have to wait endlessly.
You can:
- Pay upfront for the device
- Get a proper invoice with full documentation
- Apply for reimbursement after the fitting
Many private insurers, CGHS, and ECHS allow this route. It’s not ideal, but it avoids treatment delays.
How to Prepare for Pre-Authorisation Before You Even Apply
Think Ahead and Gather Everything Early
One of the best ways to speed up your pre-authorisation is to prepare for it before it even starts.
If you already know that your treatment or prosthetic may require insurance coverage, begin collecting:
- Recent medical records
- A formal diagnosis
- Doctor’s recommendation letter
- Disability certificate (if applicable)
- Insurance card or membership ID
- A copy of your health policy or scheme ID
Doing this early means when it’s time to file, you’re not scrambling for documents or waiting for your doctor to be available.
Choose a Provider That Knows the System
Not every prosthetic provider understands how insurance works.
Some may give you an invoice that’s not compliant. Others may miss details that insurance companies expect, like tax breakdowns or technical specs.
At Robobionics, we’ve created thousands of successful pre-authorisation files. We use the language insurers expect. We include evidence they want. And we follow up if there’s a delay—so you don’t have to chase anyone.
That experience could be the difference between a 3-day approval and a 3-week delay.
Frequently Asked Questions About Pre-Authorisation
What happens if my pre-authorisation is rejected?
You can still get treatment by switching to reimbursement mode. Most rejections happen due to missing documents or unclear medical notes. We help you fix these and reapply if needed.
Can I apply for pre-authorisation myself?
For hospital-based treatments, the hospital usually applies. For prosthetics, the provider (like Robobionics) can prepare the file, but some insurers ask the hospital or referring doctor to submit it. We guide you based on your policy.
How many times can I apply?
There’s no official limit. You can apply again if your first request was incomplete or delayed. But it’s better to get it right the first time.
Will I get approval faster if I pay extra?
No. Pre-authorisation is a formal, rules-based process. You cannot fast-track it with money. However, being prepared, polite, and thorough helps more than anything.
Your Next Step: Let Robobionics Help You Get Approved Faster
You shouldn’t have to become an insurance expert to get the prosthetic you need. That’s our job.
When you book a free demo or consultation with Robobionics, we don’t just show you how the device works—we also walk you through:
- What your insurance will likely cover
- What documents you’ll need
- How long approval may take
- What to do if there are delays or rejections
- EMI alternatives if cashless isn’t possible
We prepare your entire pre-authorisation file for you. We speak to your doctor if needed. We even follow up with your insurer or scheme so you don’t have to.
You focus on recovery. We handle the rest.
Visit https://www.robobionics.in/bookdemo/ and book your session today.
Because the faster your approval comes, the sooner you get back to living fully—with strength, dignity, and movement.