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Claim not settled even after 3 months

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25 Dec, 2022 by  shivaprasad chennoju

Hi Mahavir,

This is Shiva here. Hope you are doing good!

I underwent treatment in a hospital in Hyderabad in the months of August and September.

I was discharged on 28th September and had received cashless approval on 27th September for my personal health insurance policy. This approval was for 20 laks and the insurer was CARE.

We had already paid most of the bill. The hospital said they will reimburse the amount only after they receive the amount from Care.

Care has not yet provided the amount to the hospital and the claim is still under process.

Can you please consult us and let us know what should be our next steps?

Health Insurance

2 Answer

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Dear Shiva prasad,

I understand your question is with regards to cashless claim.

If it’s a pre approved cashless claim then hospitals shouldn’t ask you to make the payment if you have made any advance amount take refund from hospital and escalate your issue with insurance company.

Hospital and insurance company has a 45 days time to settle their settlement it’s according to the insurance company MOU.

If insurance company is not helping you then escalate the complaint to ombudsman take help of your advisor.

Thanks and Regards

Vikram Aralikatty, CFP

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26 Dec, 2022
CEO, Insurance Samadhan

Dear Shiva

Take right advise of Vikram .

Ideally , it is the responsibility of Hospital and they shpuld refund money paid by you .

In case of any dispute with insurance company, you can always reach us at Insurance Samadhan.


Insurance Samadhan

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