My mother (Mrs Vaishali Neelwarna) had and overseas mediclaim policy from New India Assurance company for 100000 USD during her 2008 stay in USA.
On 20th July 08 evening my mother complained about headache, eye pain and vomiting. On Monday, 21st July 08, the headache and eye pain became severe. So, she was taken to a doctor at Sandcrest Family Medicine. The doctor asked to do an eye check as the doctors suspected that it might be Glaucoma. So, my mother was examined by an eye doctor at Pankratz Eye Institute. The doctor confirmed that it was not Glaucoma.
Since, the headache and eye pain didn't subside and was becoming worst, she was taken in emergency at Columbus Regional Hospital (CRS) on 24 July 08. A CAT scan was done on her at Columbus Regional Hospital and the doctor did preliminary diagnosis. The doctor at Columbus Regional Hospital directed the patient to be taken to Methodist Hospital in Indianapolis by ambulance as there were no beds available in CRH.
So, my mother was taken to emergency in ambulance at Methodist Hospital. The doctors at emergency centre examined and performed Spinal Tapping and also necessary tests on her. Later in the day she was transferred to the hospital. She was in the hospital for the 8 days, till 8th Aug 08.
We started the claim process from 26th July 08. For all this time we have been receiving updates from Coris USA and New India Assurance Mumbai office that the claim is in process and would be settled soon. My mother went back to India on 11th Nov 08. On 31st Dec 08, my mother now in India received a letter from your Mumbai branch saying that "Insurance Company will make the payment for Glaucoma and the rest of the hospital treatment was for Diabetes and Hypertension and so won't be paid". The diagnosis done my the insurance company doctors of Glaucoma is totally wrong. I have medical report from the hospital showing that my mother was being treated for bilateral external ophthalmoparesis, which is infection to eye caused due to Viral infection. I have MRI scan showing this eye inflammation. Also the total hospitalisation done was for treatment of this eye infection (inflammation) and had nothing do with diabetes. The severe headaches were because of this eye infection behind her eye and were not because on the hypertension or diabetes. The neurologist who treated my mother has clearly mentioned in his reports that the hospital treatment and all the test conducted were for the above said desices and has nothing to do with Diabetes and Hypertension.
We have sent all these report and other report to insurance company, which clearly states the cause of the treatment and hospitalization. Mr. Atul Parab (Sr. Manager) from Mumbai office is looking into this claim. When my brother called he said that he is reconsidering the claim. But still has not given any positive response.
With all the given reports the case is very clear, but still Mr Atul Parab, is not ready to settle the total claim. All the report clearly say that the hospitalization and treatment was done for eye infection and low sodium level and had nothing to do with Diabetes and Hypertension, but still Mr. Atul Parab is not ready to acknowledge this fact. It is almost 6 months still the claim is not settled. Whenever we call the company says that they will settle the claim but have not said anything about the hospital payments.
Following are the Policy details.
23B-12/153200/00000598 - Medical Insurance from New India Assurance.
USA Case No. - 67159 (VAISHALI, NEELWARNA MRS)
India Ref. No. YGAC-2-02145
Policy No : 153200/34/08/45/00000598
Name: Vaishali Neelwarna
Address : 16/Deepavishwa HSG Soc
Paud Phata, Erandavana
Pune - 411038
May I request you to pls help me. I have already started getting notice from hospital for the payments.
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