The insurance company said the petitioner didn’t spend 24 hours in the hospital.
Ramesh Chandra Joshi filed an insurance claim of Rs 44,468. Joshi’s claim was denied by the insurance company.
A medical insurance claim can be made even if a person was hospitalised for less than 24 hours, the Vadodara consumer court has said. Ramesh Chandra Joshi, a resident of Vadodara, submitted a complaint against National Insurance Company in August 2017 after the company denied his health insurance claim. The judge has now directed the insurance company to give compensation to Joshi.
To quote the judge, as per an India Today report, “If the patient isn’t admitted, or is treated in less time after being admitted due to new techniques, the insurance firms can’t reject the claim by saying that the patient wasn’t hospitalised.”
Joshi filed an insurance claim of Rs 44,468 which was denied by the insurance company stating that he did not meet the requirement of spending 24 hours in the hospital. The insurance provider was directed by the court to additionally pay Joshi Rs 3,000 for mental distress and Rs 2,000 for court expenses.
As per the new order of the consumer court, patients can now claim medical insurance more quickly even without hospitalisation. The best investment you can make to safeguard your family and yourself from unforeseen medical costs is health insurance. Let’s take a look at some of the popular medical insurance schemes:
Types of Health Insurance Claims
Cashless
At the time of release, the insurance company settles the hospital bills in full if the policyholder opted for a cashless scheme. No amount needs to be paid by the policyholder up-front.
Reimbursement
Network hospitals give reimbursement in this scheme. The hospital bills need to be paid by the policyholder beforehand. When submitting a health insurance claim, the following paperwork must be included:
Health Card (Health Insurance ID Card)
Claim form from the doctor
Each report from the inquiry and diagnostic, including the blood reports, X-rays, and CT scans
Hospital invoices with records for payments
Pharmacy invoices with the corresponding medications and payment records
Report of discharge
It is essential to consider how the insurance claim is processed and paid out. In recent years, the process of settling health insurance claims has become relatively difficult.
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