user
abhijeet

Question

My wife had a miscariage in Jan 2012. During the consultation visit she started experiencing extreme pain in abdomen. Doctor advised hospitalization as a pre-caution as my wife had an ectopic pregnency earlier in Jul 2011. The TPA-TTK Healthcare has rejected the claim as- During the hospitalization no active line of treatment done hence, the claim stands rejected under exclusion.

  • Asked By: abhijeet
  • On: 11th Apr 2012 6:34 PM
  • Answered Within: 1 Days
expert
MIC Expert

Answer

Dear Abhijeet,

Mediclaim Policies usually cover treatments only and not diagnosis. However, it depends on the terms and conditions of policy as well. Since your wife did not undergo a treatment, they might decline the claim as an exclusion.

However, you can apply to the insurance company directly for a clarification other than through the TPA. If the Insurance Company does not entertain your request, you could also write to the Insurance Ombudsman who will definitely write back to you with their decision. And whatever decision they take is binding on the Insurance Company.

Insurance Ombudsman is a non judicial body for out of court dispute settlement.

Hope your query gets solved as best as possible. All the best!

  • Answered By: MIC Expert
  • On: 12th Apr 2012 10:53 PM

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