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A mistake in filling up the hospital forms can cost you your insurance claims

Taking treatment at non-cashless network hospitals, ‘unnecessary’ hospitalisation and ‘unreasonable’ charges are some of the lesser-known causes due to which your health insurance claims could get rejected

May 16, 2022 / 11:57 PM IST
Representative Image

Representative Image

When Suresh Agarwal, 64, a resident of Nagpur, collapsed at home all of a sudden in November last year, it was a bolt from the blue for his family, as he was perfectly healthy. He had to be rushed to the nearest hospital as his legs had turned immobile. “I was admitted to the ICU and the doctor’s diagnosis was that it was a minor stroke. The discharge summary noted that it was a transient ischemic attack (TIA),” says Agarwal.

He had to stay in the hospital for just two days before being discharged, much to his relief. However, this respite was short-lived as his insurer rejected his hospitalisation claim of Rs 57,000.

“They said that hospitalisation was not necessary,” says Agarwal. The company’s contention was he could have been treated on an outpatient department (OPD) basis. “This, despite the fact that the doctors recommended hospitalisation, given the severity of my condition at that point in time,” say Agarwal.

He has now registered his grievance with the company and also through the Insurance Regulatory and Development Authority of India’s (IRDAI) grievance redressal portal. “It was an acute episode and a serious, life-threatening condition that could not have been ignored. It’s the treating doctor’s call, as per General Insurance Council’s guidelines,” says Shilpa Arora, Chief Operating Officer, InsuranceSamadhan, a private firm engaged in assisting customers with complaint resolution.