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saayanbanerjee   06 January 2015

Medical reimbursement

Dear Sir/Madam,

Sub: Refusal of discharge summary from hospital and rejection of claim from insurance company, inspite of the claim being genuine

I was very sick and had high fever with severe body ache in the month of October'2014. Therefore, I was admitted to Ramkrishna Seva Pratishthan hospital, Kolkata on 14th Oct'2014. However, even after 04 days of continuous treatment with all prescribed medicines, my health conditions were not improving and high temperatures persisted throughout day and night. Therefore, on 18th Oct'2014, my family members decided to get me discharged from the hospital at risk bond and get me admitted on the same day in a higher order nursing home, namely Belle Vue clinic, Kolkata. In Belle Vue clinic, I was cured in just 02 days and got discharged fit.

Ramkrishna Mission Seva Pratishthan hospital is refusing to provide me the discharge summary inspite of our request many times, since it was a case of discharge at risk bond. The hospital administration is even unwilling to declare the nature of illness with which I was admitted and also name of the attending physician. The hospital secretary maharaj is telling that since it was a case of discharge at risk bond, therefore discharge summary cannot be provided, which I feel is illegal and unjustified. 

I produced all the hospitalisation documents to IFFCO TOKIO General Insurance Company, in which I have a mediclaim policy for 4 years. I have enclosed all the medical bills of approximately Rs 32000, diagnostic test reports, doctor's prescripttions, etc and provided to mediclaim company for reimbursement.

However, the mediclaim company is unwilling to accept the claim without discharge summary. The mediclaim company is insisting me to provide the discharge summary, inspite of me telling the claim department repeatedly that the hospital is refusing to provide the same. However, no clear clause is mentioned in the website of mediclaim company about the same. The mediclaim company is also not following up with the hospital in any manner in order to verify the genuinity of the claim and getting all the details. 

Since I have already paid Rs 32000 in the Ramkrishna Mission Seva Pratishthan, Kolkata and since I am not getting cooperation either from the hospital or from the mediclaim company in this regard, I request legal advice on how to get  medical reimbursement for the amount which I have already paid to the hospital. I desire to know the legal procedures, if any, to deal with the case. 

Regards,

Saayan Banerjee

 



Learning

 4 Replies

saayanbanerjee   10 January 2015

Dear Sir,

Thank you for your valuable advice. I propose to write a letter to the Ramkrishna Mission hospital administration, once again requesting for the discharge summary. I will draft the letter and send the draft letter to your mail id, before sending it to the hospital by post.

Thanks and regards,

Saayan Banerjee

Contact: 9940289838

T. Kalaiselvan, Advocate (Advocate)     11 January 2015

Yes you can issue legal notice to the hospital demanding the discharge summary, if they refuse to furnish, you may draw them to the consumer forum for remedy and relief.

saayanbanerjee   12 January 2015

Dear Sir,

Thank you for your valuable advice. I am planning to do the same.

Regards,

Saayan Banerjee

 

venkatesh Rao (Retired Government Servant)     14 January 2015

No more to add.


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