Mediclaim rembuirshment

SUSHIL KUMAR (Querist) 21 March 2014 This query is : Resolved
If any hospital which is under network to the insurance company where any patient gone for the treatment first in OPD, after checkup advised to admit the patient.
Patient got admitted and stay for long period of 8 days.
First cashless denied
second reimbursement denied, again gone for appeal with all the documents in orignal. Now company needs indoor case paper which he can request from his network hospital itself.
Is it correct as per law/ insurance act

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Guest (Expert) 21 March 2014
Prior approval of the insurance company is necessary for cashless treatment. Further about treatment, only the insured or his relative has to produce the proof of treatment. So, get the copies of documents from the hospital and attach the same as are required by the insurance company.

Rajendra K Goyal (Expert) 22 March 2014
You should make available the documents required by the company for deciding the claim.

Even on supplying the documents the claim is not passed approach consumer forum or parmanant lok adalat (Public Utility Services) if established in your distt.

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