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Last Updated On 04-Feb-2025
Insurance

Hospital insurance issue

I got admitted to hospital and got cashless claim approved, but the hospital insurance department is asking me to pay extra charges for room saying some amount is not claimable under insurance. But during discharge, they asked me to pay the amount to their personal UPI number and refused to accept credit card. They said they will provide cash memo bill with stamp on it by doctor When I checked with my insurance company, they asked me not to pay without mentioning it in discharge summary. Now hospital insurance team is intimidating me that they will go legally it seems. What to do?

( Hyderabad, Telangana )

03-Feb-2025

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A.
Dear Client,
In the given scenario, you should be guided by the advice of your Insurer. Otherwise, your claim from the Insurer may be rejected or repudiated. As regards intimidation or unprofessional attitude of the Hospital Insurance team, serving a legal notice to the concerned hospital, file a complaint before the Chief Medical Officer of Health(CMOH) of the concerned District, who is the licensing authority under the state-specific Clinical Establishment Act and the concerned DM/ADM of the District who is the adjudication authority under the Act endorsing a copy of the complaint to the Insurer. You can also escalate your grievance before the State Medical Council for a resolution in the matter.
Posted On 04-Feb-2025
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