Aditya Birla Health Insurance — Claim rejected due to saying that Doctor who operated is BAMS MD

Address:

Sr. No 34/1, Shejwal colony lane - 3, Kharadi, Pune

Below region mention of cliam rejection

Dear Mr. Darshan Gawari,
This is in reference towards your concern raised for the captioned policy number[protected]
We apologize for the inconvenience caused to you.
Further, we have investigated your concern raised towards the claim number 6345139 and same were repudiated.
On further investigation of the documents it was observed that The patient presented with complaints of Abdominal pain on 30-SEP-23 at SAMARTH HOSPITAL. He/she was diagnosed with Second Para Lscs Tubectomy. The submitted documents indicate surgery under SA was administered. The The Discharge summary, Hospital Final bill, Policy copy submitted / retrieved in the documents indicate. The patient presented with complaints of Abdominal pain on 30/09/2023 at SAMARTH HOSPITAL. Insured diagnosed with Second Para Lscs Tubectomy. The submitted documents indicate surgery under SA was performed. The Discharge summary, Hospital Final bill, Policy copy submitted / retrieved in the documents indicate that the patient has underwent LSCS by BAMS doctor which is out of jurisdiction of his/her license and cannot be considered. Hence the claim is being denied under clause no 36 of the policy. Hence the claim is being denied under clause no. 36 of the policy
We regret to inform you that we are unable to reconsider claim.
We express our inability to share any details in regards to discrepancy.
We trust that we have been able to respond to your concerns to your satisfaction.
For any further assistance, feel free email us at abhi.[protected]@adityabirlacapital.com.
Thanks & Regards,
Dr Gunjan more
Grievance Redressal Cell
Aditya Birla Health Insurance Company Limited