[Resolved]  Icici Lombard — Failure to Fulfill the Commitment of Insurance Claim

Address:

Bangalore, Karnataka

Its with great regret, disappointment & deep sense of betrayal i have to tell that ICICI Lombard fails to fulfill the commitment of Insurance Claim. Contrary to the promise made by ICICI, during enquiry if the opted treatment was covered under the policy. I was requested me to provide me a letter from the hospital on all the details of the treatment and the cost of the procedures to be performed. We have provided the details to Anil John who is the main Point of contact for ICICI insurance. Anil John confirmed a reply mail stating that my treatment will be covered. I was admitted in Arth hospital for 3 days (17Jul-19Jul) due to problem with Slip disc in my Spine and i was unable to even stand up. I was treated with the below mentioned procedures - Kadi Basti - Greva basti - Abhyanga and PPS - Nadi Sweda - Matra Basti (which is the same as in the letter provided to ICICI to confirm if the the treatment procedures were covered). The treatment provided are PROCEDURES performed on me and clearly not OBSERVATION. I contacted the ICICI call center as my claim was rejected, who told me that the treatment was not provided and it was mere observation. The problem i was facing is Slip disc in my Lower back and just by keeping me in observation will not cure me of the pain/problem The treatment was provided continuously for 3 days and when my body reacted positively and i was in a slightly better state, i was discharged and was advised to continue the same PROCEDURES as my treatment for 28 days by the Doctors which is done accordingly. The following actions were taken by me to opt for the claim: 1: Check with ICICI if the treatment is covered under Insurance - Contacted the In-charge of Medical claims in our Office (Deutsche bank) with the letter from the hospital on details of the treatment. I received a email stating that all the procedures mentioned in the letter is covered. 2: Admitted in the hospital from 17th Jul to 19th Jul during which the all the PROCEDURES provided in the letter from hospital to ICICI is performed. Discharge summary for the admitted period is provided along with all the PROCEDURES of treatment is mentioned on the same. 3: All hospital bills like Admission/discharge fee along with Discharge summary, Bills for the PROCEDURES perfomred, Bills for Medicines and MRI SCAN reports are submitted to ICICI to avail the claim. We have also provided the Medical treatment prescribed by other Doctors (Apart from ARTH hospital) where we consulted for second/third opinion on the treatment. 4: As directed by ICICI insurance, we are requested to make payment of the entire treatment and then submit for the claim in Insurance which is done accordingly. All the polices/procedures required in duly followed. This is absolutely unethical, unprofessional & devoid of any fairness, to me this looks like our hard earned money being used for the treatment by false promise used for rolling purpose without honoring the commitment made at the begining . Which is exactly what i read in the reviews online before the payment inspite of that i trusted ICICI on your words but to no avail. The only reply i get from ICICI is that the claim is rejected as it doesnt meet certain terms (Term 2) which states that the patient has to be hospitalized for 24hrs and procedures to be performed during the period and i have been hospitalized and procedures were performed and the same is stated on the discharge summary. But the call center tells that the ICICI doctors are not approving the claim.. I really feel cheated here as i have spent huge amount on the treatment and followed all procedures as stated by ICICI but invain. Please help! Details of the Policy/claim: Insured Name : Vijayendra Employee Name : Bn Samyuktha UHID : ILGIC/DBO/02/[protected]/H Patient Name : Vijayendra Inward Number : CL[protected] Claim Number :[protected] email add: [protected]@gmail.com