I have Had the mediclaim policy for over 15 years and almost no claims since then.
I was refused reimbursement on the basis that the procedure is a day treatment and made in to an overnite stay - thus claim refused.

Details of the case:

I had huge fibroids in my uterus and I was advised by a very senior Gynacologist at Jaslok hospital to go thru MRI Focussed ultrasound procedure as it was a new but successful way of getting rid of the intensive bleeding that I was sufferring from.

Since the fibroids were huge I had to undergo two long sessions of MRI Focussed ultrasound.
I had a five hour long session on Day 1 and the doctors were successful in destroying 80-90% of one of large fibroids . My body was stiff and I was in greast discomfort and abdominal pain due to the duration of the session as well as the size of the fibroid.

I was kept overnite to monitor pain and also to administer intravenous painkillers on 20 Sept.2011

I was taken for another session of 3.5hrs on 21 sept , equally painful and uncomfortable as they had to burn the remaining sections of the1st fibroid and also the 2nd fibroid.

My discharge card and reports state everything clearly.
I am actually surprised that the insurance company has not taken the history of the case in to account and have just tried to interpret the procedure and complications attached to it with their limited knowledge and vision.

I need justice and reimbursement of Rs 2 lacs as the matter is pending for over one and a half year.
I am insured to the tune of 7 lacs per annum

Dear Sir,

I have take a floater policy from ICICI Lombard Healthcare for a period of 2 years commencing from 15-02-2010 to 14-02-2012. My wife had to undergo laser surgery in the month of October 2011 (after 18 months from the commencing of risk period). Before my wife was admitted to Fortis Hospital, Kalyan, the hospital filled up the in the prescribed form to ICICI Lombard for availing Cashless access facility. The approval was received in the hospital on 05/10/2011 which the hospital authority informed me that the approval has been received and my wife can be admitted in the hospital. Accordingly on 7th October, 2011 my wife was admitted after conducting all pre-health check ups and test. The surgery was conducted on 8 October, 2011. Till 13 october, 2011 I did not hear anything from ICICI Lombard and the hospital authority communicated to me on the day of discharge of my wife that the cashless access has been denied/rejected. It was a great shock to me and I was put into mental agony for no fault. With great difficulty I could manage to borrow money from my friend to pay the hospital bill.which amounted to Rs, 83000/=

Under the cirucumstances i want an explanation from ICICI Lombard as to how and why did they first approve cashless access? If it was not approved initially and informed to me then II would have cancelled my plan for surgery till I had sufficient money to pay the hospital bill. The reason stated for rejection is arbitrary and without any justification. I can prove with all documentary evidences to the concerned authority that the decision of ICICI Lombard was arbitrary and unwarranted and bad in law.

I am approaching your forum to get justice and relief based on merits of my stand backed with all necessary supporting of my claim.

Regards,

TG Ramaswamy

Dear Anju,

Please provide the policy details alongwith the Insurance company information in order to give you proper advise.

As we are an alliance of top innovated , oriented Ex-bankers and legal professionals and rendering our absolutely free ONLINE services and assistance into all kind of professional financial greivances . Please feel free to write us back on askus@indianconsultantgroup.com ; If require any more assistance.

Thanking you.

Regards
Team
INDIAN CONSULTANT GROUP
Email : askus@indianconsultantgroup.com
Visit Us : India's leading independent brand valuation consultancy services.

Originally Posted by anjut

I have Had the mediclaim policy for over 15 years and almost no claims since then.
I was refused reimbursement on the basis that the procedure is a day treatment and made in to an overnite stay - thus claim refused.

Details of the case:

I had huge fibroids in my uterus and I was advised by a very senior Gynacologist at Jaslok hospital to go thru MRI Focussed ultrasound procedure as it was a new but successful way of getting rid of the intensive bleeding that I was sufferring from.

Since the fibroids were huge I had to undergo two long sessions of MRI Focussed ultrasound.
I had a five hour long session on Day 1 and the doctors were successful in destroying 80-90% of one of large fibroids . My body was stiff and I was in greast discomfort and abdominal pain due to the duration of the session as well as the size of the fibroid.

I was kept overnite to monitor pain and also to administer intravenous painkillers on 20 Sept.2011

I was taken for another session of 3.5hrs on 21 sept , equally painful and uncomfortable as they had to burn the remaining sections of the1st fibroid and also the 2nd fibroid.

My discharge card and reports state everything clearly.
I am actually surprised that the insurance company has not taken the history of the case in to account and have just tried to interpret the procedure and complications attached to it with their limited knowledge and vision.

I need justice and reimbursement of Rs 2 lacs as the matter is pending for over one and a half year.
I am insured to the tune of 7 lacs per annum

Dear Mr. Ramaswamy,

We have gone through your whole post and can understand your problem. But would certainly like to inform you that this kind of problem hardly happens with I-Lombard.

Anyways We would suggest you to escalate this matter to preeti.lochan@icicilombard.com and mark a CC to bhargav.dasgupta@icicilombard.com in order to have a better response and proper reason for this act.

As we are an alliance of top innovated , oriented Ex-bankers and legal professionals and rendering our absolutely free ONLINE services and assistance into all kind of professional financial greivances . Please feel free to write us back on askus@indianconsultantgroup.com ; If require any more assistance.

Thanking you.

Regards
Team
INDIAN CONSULTANT GROUP
Email : askus@indianconsultantgroup.com
Visit Us : India's leading independent brand valuation consultancy services.