I have been a customer of a prominent private health insurance company for 4 years. This is an individual health policy and I have not had any claim for 4 years. In August 2016, I was advised a minor procedure for which the company denied cashless claim without assigning any reason. A few months earlier I had been diagnosed with another illness which has rendered me disabled. After 3 months and 9 I duration is of filing claims, the company finally refused to provide any reason and said I can contact ombudsman. I contacted the ombudsman in Bangalore and he refused to intervene stating that unless there is a dispute of money, he cannot do anything.
This since I am short of money, I cannot take the risk of spending more than Rs. 100,000 and then finding that the company has denied the reimbursement for a reason which is probably the same as the reason for denial of cashless claim but I will not know until I finish the procedure. Right now, I'm managing my secondary illness for which the procedure was advised conservatively.
My question is that if the government cannot protect up customer in the case of denial of cashless claim, then what the course does a consumer have?
After talking to some of the other patients I had met in a hospital, it seems that health insurance companies routinely denied cashless claim so that patients have to pay upfront for their procedure is and then the companies will push them towards a settlement instead of paying the entire amount. Since the consumer has already paid and is probably in financial distress, therefore she would be willing to settle for a much lesser amount.
Can anyone please advise on how to handle this or if one can file a petition similar to class-action lawsuit
