Reimburse claim denied
vijay waghmare
(Querist) 06 August 2014
This query is : Resolved
Hi some days before my wife hospitalized for bed rest some how 6 days unfortunately treating doctor is of MS(AYURVEDA)for that reason insurance company has been rejected my claim. does one have any supported documents to approve my claim.
Devajyoti Barman
(Expert) 07 August 2014
Treatment of Ayurveda is not recognised in many govt. departments.
Nest time get her checked by MBBS doctors.
Akhil Dave
(Expert) 07 August 2014
Dear Vijay Waghmare,
The Medicalim insurance policy does not cover expenses for treatment for general debility and convulsions or rest cure illness. Similarly, there are many policies which does not cover treatment of Ayurveda and Naturopath.
First check your insurance policy if properly worded provided to you by your insurance company. If not, than its good case to file in consumer court.
Even, You can prefer consumer case on various available ground for indemnity.
Warm Regards,
Akhil Dave, 09429313680
Advocate & Consultant [Consumer Act]
Rajendra K Goyal
(Expert) 07 August 2014
Refer the terms of policy document.
If Aurvedic treatment is covered, file consumer complaint.
Guest
(Expert) 07 August 2014
Government recognises Ayurvedic treatment to some extent, but not the insurance companies.
Advocate. Arunagiri
(Expert) 07 August 2014
Many insurance companies, allow certain percentage of the claim for Alternate medicine. You have to check your prospectus.
vijay waghmare
(Querist) 08 August 2014
thanks for your response i have same checked with hospital about denied the claim they have provided me the Govt. GR to submit as a supported document that also i have forwarded to TPA but till i do not have any response from them. here i am given the below GR No. for your reference pls have look if any solution on the basis of that.
RNI No. MAHBIL/2009/40123
Reg. No.MH/MR/South-356/2012/14
if you want i have GR copy
vijay waghmare
Kumar Doab
(Expert) 08 August 2014
You have been advised in detail by the experts.
If TPA is maintaining studied silence or is not adhering to contract and govt. guidelines you can agitate and file complaint in DCDRF.
As advised by Mr. Dave your lawyer can help you and find out the grounds and logic for complaint.
In a case M/s Raksha TPA was found to be employing BAMS Doctors with them for handling the claims that was also found not permissible. The Insurance Company M/s United India Insurance thereafter helped and matter was sorted out.
You may show the GR's to your lawyer and proceed under advice of your lawyer.
T. Kalaiselvan, Advocate
(Expert) 09 August 2014
Well addressed and properly advised by all experts, you may follow them or take the aid of a local advocate to guide you accordingly.
Raj Kumar Makkad
(Expert) 10 August 2014
Rightly advised by the experts hence no more to add.
R.venkatesh Naidu
(Expert) 20 August 2014
but recently in Tamil Nadu state commission pronounced a judgment that the Ayurveda or homeopathic treatments are not covered under medi claim policy
Kumar Doab
(Expert) 21 August 2014
Mr. Naidu,
Please provide link to the decision of Tamilnadu State Commission. It shall help everyone.
Raj Kumar Makkad
(Expert) 21 August 2014
I have tried to search the link as referred above but failed to get it hence I also do request Venktesh to provide such link as this is very important for all of us.
