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apurv mishra   21 April 2022

Insurance claim denied

My wife had a surgery due to polyp, now the insurance company is asking for the Indoor case papers feom the hospital. But hospital and doctor is clearly denying it and they mentioned that it is only required in special cases where there is some complication. We contacted the insurance company and stated the same to them, but they have mentioned that without Indoor case papers they will not proceed with reimbursement. We are stuck now. Please suggest what can be done



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 4 Replies

Rama chary Rachakonda (Secunderabad/Highcourt practice watsapp no.9989324294 )     21 April 2022

get a letter from insurance company and submit to the concerned doctors. so that they may give on the basis of insurance company letter request.

shraddha Easwaran   22 April 2022

Dear querist,

One of the options for you is that you can, you can request the insurance company to draft a letter requesting the hospital to provide the needed documents and reports.

Additionally, it is not fair for the hospital to deny providing the needed documents. So, if you ask them for the documents, it's their prime duty to provide them to you.

Thankyou,

Shraddha

apurv mishra   24 April 2022

Dear Sir, I have submiited the request from the insurance provider to the hospital, but the doctor has denied to give it stating that only in case of  Medico-Legal matters they can be asked by Court or Medical Authority of the state where Hospital is registered.

Anurag Kumar   18 May 2022

I think you trying to say that doctors denied the papers are the treatment is not an IPD treatment but a day care treatment. Your wife might not have hospitalized for more than 24 hours, in that case it falls under purview of day care treatment. Please file the claim with Insurance company as Day Care claim. Most of the day care treatment is covered under new health insurance policies.

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