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Wrong deduction maxbupa corona kavach

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17 Jun, 2021 by  Vikash Chordia

Sir i had claim but they did wrong deduction saying o2,consultation are included in room rent whereas its clearly mentioned in hospital final bill that it was charged separately. Kindly help how can i proceed further.and it is corona kavach policy where no roon rent limit

Claim amount - 187734

Payable amount – 104000/- 

 

·         Deduction – 83742 /- spirometer 703, easy fix 49, MRD 500, oxygen , consultation, consumable charges are part of room rent 41000/- , covifor 2450, 1000 lab test part of room rent , imicrit injection no indication 29032

And even after calculating deduction there was total mistake of around 10000

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17 Jun, 2021
Sandesh Shetty

In the initial phase of Covid-19, Many Insurance companies & TPA's were unsure about the rate being charged for Covid hospitalization so they decided to go with GI council rate which categorized the hospital in NABH & Non NABH hospital and accordingly Per day rate was decided based on moderate to severe sickness. This per day rate included Consultation, Nursing Charges, Room Stay & Meals ,COVID testing, drugs, etc.


However after a brief period it was decided to settle the claim based on policy terms & condition & not according to GI council rate and later on IRDAI came up with Corona kavach policy with its own respective terms & conditions.


In your case it seems that unnecessary deduction has been done considering Corona Kavach policy is not like any other retail policy but the policy terms & condition being drafted by IRDAI which is same irrespective of Insurance companies.


The policy terms & condition clearly states that Room rent is only inclusive of boarding & nursing expenses, so thereby expenses incurred for Oxygen, Consultation, lab test, etc can't be subsumed under room rent. However other non payable item as per policy such as Spirometer, etc will not be paid and injection charges can't be excluded unless & until it is proved that it is unrelated to the illness for which the patient was hospitalized.


Action to be taken stepwise if the issue is not resolved

1) Approach their grievance department which is stated in their policy document.

2) Lodging complaint at IRDAI Integrated Grievance Management System: https://igms.irda.gov.in/

3) Finally approaching Insurance ombudsman.


Hope this helps !!



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17 Jun, 2021
Vikash Chordia
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17 Jun, 2021
Sandesh Shetty
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19 Jun, 2021

Dear Vikash,


This case needs carefully analysis. I would like to offer you a free assessment of your case. Can you email the soft copy of discharge summary, hospital bill with breakup and insurance settlement letter to my mail id anuj@sureclaim.in


I run an insurance claim advisory and prepare several such claims. Send across the documents and I can share very specific inputs on your case.


Anuj

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