With reference to the above said medical policy, claim of Rs 17836.00 was rejected on 15th June 2013 stating unable to sanction cashless benefit. In the above said matter, we want to state that patient had a second episode of sudden onset of loss of movement in right side of body followed by perspiration and severe headache. Then on the advice of Dr. Anil Vardani, Senior Consultant B L Kapoor Memorial Hospital, the patient was hospitalized for diagnosing the problem. Investigations revealed leukocytosis, decreased vitamin B12 and 25 OH vitamin D levels. But no major disease was revealed in the tests. Thus, it is good for the patient and his family that no major diseases was revealed during the procedure. As requested in 15th June 2013 denial letter, the claim was resubmitted again. However, we received a denial letter dated 22nd July 2013, by stating the claim falls under clause 4.10 of the policy. The letter also states that the patient was admitted only for investigation purpose, no active treatment taken. For your information, the doctor prescribes all the investigations on examining the patient’s condition. This is not the patient’s fault that he was not suffering from any major disease and no major treatment was given during hospitalisation. However, according to letter the patient should suffer from some major disease only to get the claim. Instead of being happy on the patient’s health they are criticizing on the fact that why he was not suffering from any major disease.

Full Hospitalisation claim of Rs 17836.00

Complainant Information
name- sanjeev1962