Regarding the cashless treatment

24 Sep, 2022 | by harivansh agrawal

My question is this even legal to say that you are entitled to any room or no room limit but the hospital said that we don't have an MOU with your insurer for that room or for that surgery

A case happened to me even though in my mother's policy (Niva Bupa Reassure) there is no mention of a limit on the type of cataract lenses or any kind of limit on cataracts the hospital said that We have an MOU up to mono-focal lenses not Multi-focal if you want to get Multifocal lens you will have to reimburse it I think this happens in room rent also If I wanted to choose the suite the Hospital does allow this as they don't have an MOU

don't you think why to say you have this number of network hospitals If I can not take my surgery cashless

I know Cashless is just a service of patient convenience but I think they should mention that they may have an MOU for this hospital for this kind of surgery or this kind of room they did not that they may have an MOU with the hospital but in the policy wording, there is no kind of sentence in this topic

I keep arguing with the hospital staff about that but once I know about it in detail and by reading Mahavir sir's tweet I was very much pissed about it...

why put this statement of no room limit, any kind of surgery if you can't use it

Health Insurance

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24 Sep, 2022

Shailesh Kumar

CEO, Insurance Samadhan

Dear Mr Agarwal

You have two questions

1. Room rent : there is no limit on room rent but all expenses like Doctor visit , OR are linked to room rent. Would be willing to pay premoum rates for same treatment and exhaust your sum assured. So hospital generally deny deluxe rooms on lower sum assured to avoid disputes at later stage . Yes , you are entitled to higher room rent amd there is no mou with any hospital .

2. Cataract has a fixed sum assured of rs 40000 to rs 75000 . Ypu will get maximum sum assured only irrespective to amount spent by you .

Hope this clarifies

Shailesh Kumar

Insurance Samadhan

1 Comments

24 Sep, 2022

harivansh agrawal

Thank you sir for answering

I know everything is linked to room rent, in this case, the person had insurance of 10 lac (no room rent limit) the hospital staff explicitly told him that they have an MOU up to a single ac room, not above that so if you want to have a deluxe room he will have to reimburse with the insurance company latter

all this is for the minor surgery of MINI-PCNL

In the same case with Cataract surgery, the policy document does not mention any kind of limit in Cataract surgery in the case of My policy (Niva Bupa Reassure), I know some policies have a limit but mine does not have any that is what I told them even then they said we had talked to there supervisor they said the same answer we have an MOU up to the limit of the mono-focal lens not multi-focal, even not for higher-end mono-focal like Eyhance, some middle variants if you want that lens you will have to reimburse the surgery later

Just asking two different hospitals for two different surgery can they give the same answer that they don't have an MOU with the insurer

can they both lie

and again

Thank you

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Regarding the cashless treatment

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