Comments
Dear Shweta,
AL enhancement:[protected]
Requested amt : 38260
AL status : Rejected
Remarks : Others - Kindly note as the disease sub limit available under the policy has been exhausted, hence further enhancement of limit is not approved. During final settlement of claim, any excess amount that has been approved at the time of initial authorization or subsequent limit enhancement, discounts and expenses incurred on non-medical expenses shall be deducted. Final claim settlement will be done strictly as per the terms and conditions specified in MOU.
As per policy certificate customer opted Sub limit “C” Please refer below sub limit table as per current product.
And current ailment “Other specified fever” falls under “All Medical Expenses for any treatment not involving surgery/ medical procedure”. Therefore our liability for said ailment is Rs. 25000/-for each Hospitalization
Note : the reason for sanction Rs. 25000/- for two admission is :
As per policy the sub-limits mentioned above shall be applicable for each Hospitalization. For the purpose of applicability of the said sub-limits, multiple Hospitalizations pertaining to the same illness or medical procedure / surgery occurring within a period of 45 days from the date of discharge of the first Hospitalization shall be considered as one Hospitalization.
AL enhancement:[protected]
Requested amt : 38260
AL status : Rejected
Remarks : Others - Kindly note as the disease sub limit available under the policy has been exhausted, hence further enhancement of limit is not approved. During final settlement of claim, any excess amount that has been approved at the time of initial authorization or subsequent limit enhancement, discounts and expenses incurred on non-medical expenses shall be deducted. Final claim settlement will be done strictly as per the terms and conditions specified in MOU.
As per policy certificate customer opted Sub limit “C” Please refer below sub limit table as per current product.
And current ailment “Other specified fever” falls under “All Medical Expenses for any treatment not involving surgery/ medical procedure”. Therefore our liability for said ailment is Rs. 25000/-for each Hospitalization
Note : the reason for sanction Rs. 25000/- for two admission is :
As per policy the sub-limits mentioned above shall be applicable for each Hospitalization. For the purpose of applicability of the said sub-limits, multiple Hospitalizations pertaining to the same illness or medical procedure / surgery occurring within a period of 45 days from the date of discharge of the first Hospitalization shall be considered as one Hospitalization.
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We have made a note of the details mentioned. We will check this from our end and get back to you with an update.
Regards,
ICICI Lombard General Insurance