Medical claim reimbursement need indoor case paper must?
amitvikram
(Querist) 11 March 2015
This query is : Resolved
Dear Sir/Madam,
My daughter, after birth was kept in NICU for 7 days in jyoti punj hospital, Patna, Bihar.
I have Submitted all required document(Including Bill,Blood Test report etc) to Health insurance company but they are demanding Indoor case paper's photocopy too for processing claim.
But the hospital is not ready to give me photocopy of indoor case paper.
Please suggest.
Regards,
Amit Vikram
Kumar Doab
(Expert) 11 March 2015
Is it demanded in writing?
If No ask to supply the demand in writing?
If yes or even if NO minute the discussion in writing and under proper acknowledgment and reply that hospital has declined.
Provide Discharge Summary duly certified by the MO/Neonatologist.
Rest the insurance company can visit the hospital and examine by themselves.
amitvikram
(Querist) 11 March 2015
Hi Kumar Doab,
Thank you for your quick reply.
Yes the insurance company has sent me email with their requirement.
Also, I have already submitted dicharge card.
I have sent an email to hospital, with insurance persons in cc and asked them to reply.
Will wait for hospital's reply.
But what should happen to my claim if hospital denies on email too?
Please let me know your thoughts.
Regards,
Amit Vikram
Kumar Doab
(Expert) 11 March 2015
If hospital has declined to provide verbally (as posted by you) record it in minutes................with date/time/name of hospital staff...............and escalate to MS/MD/Director/Owner of the hospital in writing.........and demand supply it to you or insurance company even if as an attachment as soft copy...........with a copy to you.....so as to reach in say next 3 days..........
Thereafter you can approach your lawyer.
Rajendra K Goyal
(Expert) 12 March 2015
If the hospital has declined the information and Insurance company rejects the claim, file consumer complaint against the hospital and the Insurance Company.
ajay sethi
(Expert) 12 March 2015
hospital is bound to furnish complete medical record of the patient within period of 72 hours from demand . if hospital refuses to do so issue legal notice to hospital for deficiency of service in this regard
ajay sethi
(Expert) 12 March 2015
The Medical Council of India has imposed an obligation on Hospitals as per the
regulations notified on 11th March 2002, amended up to December 2010 to maintain the
medical record and provide patient access to it.
Every physician shall maintain the medical records pertaining to his/her
indoor patients for a period of three years from the date of commencement of the
treatment in a standard proforma laid down by the Medical Council of India and
attached as Appendix 3.
1.3.2. If any request is made for medical records either by the
patients/authorised attendant or legal authorities involved, the same may
be duly acknowledged and documents shall be issued within the period of
72 hours.
Kumar Doab
(Expert) 12 March 2015
As already pointed out demand to supply authenticated copies in 3 days time.
T. Kalaiselvan, Advocate
(Expert) 13 March 2015
