I am covered by a group health insurance scheme of M/s New India Assurance Co. Ltd., Chennai. Now I am suffering from Kidney failure and need to undergo Dialysis thrice every week since Feb. 09. I have been submitting hospital bills on a monthly basis and the insurance Co. have been reimbursing the amount spent. They deducted Rs. 12, 915/- from my claim for the month of July, ’10, on the grounds that some hospital bills supporting my claim did not provide details of material used for dialysis. I replied, stating firstly that they have been settling all my claims both previous to and subsequent to the claim for the month of July, ’10 where some supporting hospital bills may not give details of material used for dialysis but there was never any objection. If details of material used are necessary, then why did they not ask for these when settling my other claims? If these details are not required then why are they asking for them to settle this claim? Secondly, the 14 hospital bills for dialysis during July ’10, can be divided into two categories. Those where the total amount charged is Rs. 2, 604/- and those where the total amount charged is Rs. 1412/-. One bill, totaling Rs. 2604/- has details of material used. Similarly, one bill totaling Rs. 1412/- has details. It is obvious that all other bills wherein the treating hospital is the same, patient is the same, the month when procedure was performed is the same, the process is the same & totals are the same, the material used will also be the same. So, details of material used for dialysis already with them, for all bills and thirdly, the treatment to be given and the material to be used for such treatment is entirely at the discretion of the treating doctors/hospital and any alteration there does not alter the liability of the health insurance Co. This was pointed out to them.
However, the insurance TPA refuse to pay the deducted amount.
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