Indoor case papers mandatory psychiatric treatment

Querist : Anonymous (Querist) 01 November 2022 This query is : Resolved
Hi,

We have admitted my mother for psychiatric treatment in the hospital for 4days and post that I've applied for the reimbursement for the same . The insurance people are asking for the Indoor case papers after providing all the documents. So I spoke to the hospital people for providing those indoor case papers and they are saying as its Psychiatric department the indoor case papers are not allowed to provide out of the hospital and it's a kind of confidential itseems. So they are not ready to provide a copy of those papers and I've informed the same to the insurance team but they are saying they will not be able to process the claim without those papers.

Please suggest on this .

Thanks in Advance.

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Quick Summary

A user is facing difficulties getting their insurance to reimburse psychiatric treatment costs because the hospital won't provide 'indoor case papers' due to patient confidentiality. The insurance company insists on these documents. Experts suggest the insurance company should arrange inspection of the papers at the hospital rather than demanding copies from the patient. If the insurer refuses to process the claim, consider escalating the issue to the Insurance Ombudsman or filing a complaint with the Consumer Commission.

kavksatyanarayana (Expert) 01 November 2022
The doctors shall certify to that effect and they have to issue the expenditure bill with their signature. But they may not give all the inpatient papers.

P. Venu (Expert) 01 November 2022
You may take up the issue with the Insurance Ombudsman.

Advocate Bhartesh goyal (Expert) 02 November 2022
It is gross deficiency of services of Insurance company to demand indoor case papers for reimbursement of treatment of insured person.Insurance company can get inspected throught its agent indoor case papers in hospital if requirement of these papers are
essential to reimburse the treatment expenditures.Insured person has to only provide medicine bills, discharge ticket of of insured and diagnostic reports to insurance company.issue notice to Insurance company and demand your treatment expenditure and if notice not complied with by insurance company then file complaint before Consumer Commission.

Dr J C Vashista (Expert) 03 November 2022
I concur the expert's advise

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