A disturbing incident has emerged where a woman alleged that her insurance company had subtly denied her insurance when her husband was dealing with extreme pain and infection in the hospital.
The woman named Pooja Bariyar shared the incident on her channel Pooja Bariyar vlogs where she recounted how the insurance company ICICI Lombard did not approved of the claim which she had raised for her husband’s cashless treatment at Max Hospital.
According to Pooja, the family had taken a health insurance plan of 25 Lakhs cover for an yearly premium of Rs 25,000. Pooja also claimed that they had taken multiple add-ons and riders to ensure best coverage possible for different scenarios.
Claims by The Woman
That after raising the claim request, the insurance reverted back on email of not receiving the complete documents in order to review the claim request.
Upon contacting the hospital TPA, they claimed that they had sent all the necessary documents which are needed initially to start the cashless treatment.
On the next morning, the complainant received a message from ICICI Lombard that their claim request is rejected due to incomplete documents.
The woman claims that the insurance company had not reverted back to the hospital TPA about the incomplete document issue
Pooja then opines that the hospital TPA sent all the documents again in front of her to the insurance company. The complainant and her husband confirmed with the insurance provider whether they had now received all the necessary documents to which they replied that they have.
The insurance then sent a TPA team from their side to verify the authenticity of claim request. After a few hours, the insurance asked for all the past hospital records of the patient. The wife, Pooja opines that all this to and fro communication was being done with her husband (patient) and not from the hospital.
After receiving the health records of the patient, the insurance again asked the patient to provide even more past hospital records of the patient. “This only meant that they were simply trying to harass us mentally.” Pooja said.
Forced to pay from own pocket
Pooja opinions that the constant mental harassment from the insurance authorities meant that they had to pay the hospital from their own pocket to start the treatment. Luckily, the bill came of nearly Rs 50,000 only.
Legal Battle
The complainant in her vlog that she will go the legal route for the agaony that she has faced due to this whole ordeal. She has submitted her complaint to the ombudsman and also to the consumer court.
This is not the first time in India that such incidents have been narrated by victims online. Due to social media, many such incidences are now coming online and helping people to choose the right insurance provider for their coverage.
