[Resolved]  IndiaFirst Life Insurance Company — FAILURE TO REIMBURSE THE HOSPITALIZATION EXPENSES

Address:

Visakhapatnam, Andhra Pradesh

I obtained India First Money Back Health Insurance Policy Vide No. 10206181 during 2012 through Bank of Baroda, Yernagudem and since then I am paying my premiums regularly. It was sometime during January 2013, I felt excruciating pain in my right leg which made me completely immobile thereby warranting emergency treatment under Neuro Surgeon. It was on 09th January, 2013, I was admitted as an in patient with Indus Hospitals, Flat No.18-1-6, KGH Down Road, Visakhapatnam -530 002, Andhra Pradesh under the care of Dr.T.Suresh, .M.Ch (NIIMS), Consultant Neuro Surgeon who diagnosed the problem as "LUMBAR CANAL STENOSIS L1 TO L5 WITH SEVERE L4/5 PIVD" and advised immediate surgery. I was admitted to the hospital on 09th January, 2013 at 1.58 PM and tried to contact your helpline for seeking prior authorization on the same day. Since, I could not get any assistance online, I underwent surgery successfully and regained consciousness on the next day in early hours. It was on 10th January, 2013, I again called your Help line and asked them to process the claim for reimbursement of medical costs which was declined by your Customer Service Executive citing the disease for which I undergone treatment is pre-existing over the last two years. I promptly declined the reason cited by your Executive citing the medical examination which I have undergone prior to obtaining the Health Policy as I have crossed more than 49 years by the time, I took the policy. I hope you will not feel the matter out of point, as the comprehensive health check up done by your panel doctor could not detect the disease and the Surgeon who conducted my surgery in his diagnosis report as well as discharge summary mentioned the existence of the problem for over the last 2 months. For your reference, I would like to quote the Neuro Surgeon's comments for admission [protected]@ C/O severe LBA and radiating to the right leg 2 months, known hypertensive and diabetic since 10 years". Basing on the remarks made by the intervening Surgeon, it is evident that the disease is not existing prior to the taking of the Health Policy but has been cropped up over the last 2 months owing to my professional rigor. By passing all these comments, Your Customer Care was bent upon to reject the claim in your usual way of disposal "prior existing diseases are not eligible for claim" which are nothing but a tool in your hand to fool the consumers. It was never revealed in your Panel Doctor's Report, similarly, I did not undergo any treatment for the captioned problem and when the problem got aggravated, the intervening surgeon who conducted the surgery opined that the disease must be prevailing over the last 2 months, which cannot be over ruled by your Company just for the sake of shaking off your responsibility. You are a public Health Insurance provider and you are governed under Insurance Development and Regulation Act and Consumer Protection Act, and ignoring the main essence of taking the cover under health care is nothing but criminal misconduct on the part of Insurance provider. I made several contacts to you through your Help line, as well as by sending a note to your registered address. We even sent an email to your id < customer.[protected]@indiafirstlife.com" But noting could yield the desired results. Such being the situation, I call upon you finally, to intervene and resolve the issue within 2 weeks from the date of publication of this complaint on this forum, failing which I will be constrained to take action before an appropriate forum for the claim of Rs. 2, 50, 000 with costs, which may please be noted. Pinnamaneni Raja Rao 3-56, Gandhinagaram Sangayyagudem Post West Godavari District - 534 313 Andhra Pradesh Tel+91-[protected] Email: [protected]@gmx.com