Upgrad LLM

health insurance claim


I had undergone treatment in an non networked hospital after taking necessary confirmation from my insurance broker. When I submitted my claim, the same is rejected mentioning the treatment is not covered under the policy but insurance broker had given an pre confirmation that the treatment is covered. I am following with the insurance broker but he is not ready to clear the claim. Please guide me on the next steps
 
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The claim is pending from Mar'2019
 
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LEGAL

You need to check with Insurance company ,may be the broaker lied to you...there is requierment od approval for anyother uncovered treatments ...just check with the co. directly.

 
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Thanks for your kind reply.

For my company, Insurance broker is the only point of contact. I have undergone the treatment based on the Insurance brokers confirmation. Now, Insurance broker has informed that the Insurer is not clearing the claim.

Please let me know can some action be taken on Insurance Broker.

 
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check your policy documents if particular treatment is covered under policy or not.
if the treatment is covered then serve legal notice for payment.
if compacy deny payment then file case in consumer forum.
 
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Thank you Mr Deepak for your kind suggestion. The confirmation received from Insurance Broker and not the insurance company. My insurance broker is the only point contact for any claim related clarifications. As per the policy, the treatment is covered but it is under life threatening condition. Hence I had mailed the medical certificate issued by the doctor to the insurance broker for their review and confirmation before undergoing the treatment. They had confirmed that the treatment is covered. Now after I submitted the bills, they are saying that my condition is not life threatening and the claim is non payable. I wrote to the insurance broker many times informing that the treatment was taken based on their approval and hence they have to honor the claim. But there is no positive response from them. Please help me with a solution to deal with this matter. Thank you.
 
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Move to consumers court along with all details and confirmation from treating doctor stating medical procedure was necessary.
 
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Move to consumer court along with valid documents.

 
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