I have been cheated by My Health Insurance provider and need your help in getting me justice.
Insurer: Manipal Cigna Health Insurance
Policy Inception Date: 10-Oct-2018
Manipal Cigna is denying with the document named Insurer_09262021_MedicalReport.pdf
I am fighting to prove with the documents named Proposer_09262021_DischargeSummary.pdf and Proposer_10062021_MedicalReport.pdf
My request is to look at the document that they are considering and also the documents that I am providing and give a fair judgment to my case.
More details can be found in the below email and I can provide a more detailed sequence of events if required.
On top of all these they are harassing us stating we will discontinue the policy.
What I want to just emphasize is the issue is from 5-6 months and not from 5-6 years as assumed by Manipal Cigna and I want them to reconsider and open my claim.
Manipal Cigna Team is not willing to reconsider my Claim and are providing the below reasons.
On scrutiny of the documents, it has been observed that We have received claim documents for, claimant admitted at Kasturba Hospital Manipal from 22/09/2021 to 26/09/2021 with the Complaints of Bilateral Knee Osteoarthritis. Claimant is covered under Manipal Cigna ProHealth-Protect V3 - Non-Floater policy since 10/10/2018. As per the available documents, patient is a known case of Bilateral Knee Osteoarthritis since 5 to 6 years. The ailment is pre-existing in nature. The pre-existing diseases and related complications are not admissible under the policy for a period of 48 months, hence the claim stands repudiated under the Policy Clause V.1. Pre-existing Disease Waiting Period. Also, the said ailment was not disclosed at the time of Policy inception, hence the claim stands repudiated even under Policy Clause VIII.1. Duty of Disclosure. We regret our inability to admit this liability under the present policy conditions. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.
All Grievance Level in Manipal Cigna is handled by the same team
Level-1 [protected]@manipalcigna.com
Level-2 [protected]@manipalcigna.com
Level-3 [protected]@manipalcigna.com
Level-4 [protected]@manipalcigna.com
They have made up their mind to deny the claim. Any email sent by me to any grievance level is addressed by one team and I get the same reply. They are not considering my corrected documents provided by a well known Hospital itself.
They are denying it for the below
Mismatch in Admission report and Discharge Summary due to mistake by Duty Doctor
The Duty Doctor wrongly filled the issue as from 5-6 years in the admission report while the main Doctor rightly mentioned it as the issue from 5-6 months. Manipal Cigna denied my claim by considering the admission report. However, the main doctor immediately corrected the report, handed over the corrected attested copy and updated the documents in their records.
I was expecting Manipal Cigna to reconsider my Claim with these documents. However, they don’t want to reconsider it at all.
As per my last call, they say below
Bilateral Knee Osteoarthritis will always be there from a longer time and not start from 5-6 months
The patient did not notice any issues in the past and always was fit and fine. However, sometime in Aug 2020, her Husband suffered from Hemiplegia ( Paralytic Stroke ) and lost sensation to the left side of the body. This might have caused the patient with more workload. However, since she started developing pain, she consulted the doctor on 16th July 2021 and even at that time the Doctor prescribed medicines and asked us to follow the medication. However again the pain was not bearable and the doctor examined the X-Ray and suggested that we go for the surgery. So, in this case should we not consider the issue as it started only from 16th July 2021 ( around 5-6 months back)?
We always think that any disease should not be neglected and treated immediately. Neither prepone or postpone. Some examples to prove that
We neither prepone or postpone any hospitalization to take the benefit from the insurer
a) One of the policy holders went for cataract operation just after completing 1 year of the policy. We did not wait for the 2nd year to take the benefit of 2 year waiting period
b) The same patient went for cataract operation of another eye just a month after attaining 65 years. We did not prepone the operation just to avoid the 20% copay after attaining 65 years.
c) Similarly, we went to the Doctor for knee pain only when the pain started but somehow, we are failing to convince Manipal Cigna.
Apart from this now they are also assuming that we did not disclose this during policy inception (Oct 2018)
The patient was perfectly fine during the policy inception and hence there was nothing specific to disclose.
a) The patient went to the dedicated checkup center just before the policy inception and underwent all the tests that were recommended.
b) Since the patient was fine, she was also able to travel domestic and international. A patient with knee problems would have not been able to travel for tourism purposes.
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