Anesthesia claim not approved by Mediclaim insurers

I had applied for my mediclaim insurance on 20th October, 2015 for an amount of Rs. 50441. However, I was granted a claim of only Rs. 46294. I was given no details on the basis of deduction of amount from my claim.
On further inquiry, I was informed that the claim was reduced as the anesthesia bill and consumables were not covered under the claim as per policy. (Response to complaint no. PG0024872015 dated 17/11/2015).
My particular grievance is solely in relation to the amount deducted for the claim on the anesthesia amount which amounts to Rs. 3500. The auto-generated reply informed me that the amount was deducted under clause 1.2C of the Policy.

Clause 1.2C of the Policy claims that the anesthesia bill would not be granted if it is not included in the hospital bill. However, that is not the situation in this case. To satisfy that particular clause of the policy, I had specifically attached the letter of the hospital signed by my doctor which specifically says that I received the anesthesia while at the hospital in relation to the concerned surgery.

Therefore, it does not seem feasible to me that my claim is deducted on this ground for two reasons. Firstly, I have satisfied the requirement of the anesthesia being a part of the hospital bill by providing the letter. Secondly, even if it is assumed that the letter does not fulfill your requirement, the clause in the agreement is wholly arbitrary and there is no basis for such a clause because the link between the hospitalisation and the anesthesia is fulfilled by providing of the letter.

Deepan Shah
Ahmedabad 380015, Gujarat
Email: / 10/01/2016 / 1:05 pm

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