New India Assurance Claim has been denied

Report
Question

Please briefly explain why you feel this question should be reported .

Report
Cancel

I have corporate Mediclaim Policy under MEDICARE TPA Srevices. Policy No. 920000/34/16/04/00000001

MAID: [protected]

Claim Number H[protected]F[protected]

 

Initially, I went for cashless treatment, and it got a query was which was answered by Doctor/Hospital and by late evening it was approved.

But Hospital had already given the discharge summary, and if I had stayed for more they would have charged again and a new discharge summary

was to be issued(as per hospital billing). So, I paid the bill and applied for later reimbursement.

 

First they asked a query – Why the patient was admitted as the treatment could have been done on OPD basis.

Doctor/Hospital answered that as the patient had severe anemia and required blood transfusion immediately so need to be admitted.

 

But, now after one month of applying for reimbursement, I get the email that the claim has been denied.

 

Reason for denial:

On scrutiny of claim documents, it is found that patient Kamla Devi received conservative treatment (Blood transfusion) for the

condition of severe anemia, RA and osteoporosis, patient was admitted primarily for anemia, confirmed in query reply provided

by hospital. As anaemia is not payable as per current policy terms and conditions, claim stands denied. We regret our inability

to process the claim.Since the claim does not fall within the purview of the Policy terms & conditions, we regret our inability

to admit the claim. If you have any other information or documents to substantiate admissibility of the claim, please provide

the same within 15 days of receipt of this email/letter.

 

When it was approved while cashless, how come the same can be problematic later, as the treatment was same.

While the patient was admitted they even visited hospital to check and gave a “get well soon card”, and now at the end claim denied,

in-spite of having this medical insurance for many many years. Shameless people.

0
Sudhir Bisht 4 years 0 Answers 98 views 0

Leave an answer

Browse
Browse