Mims Hospital — Anomaly in Insurance Claim Approval

NOTICE OF INSURANCE CLAIM DISPUTE

To Whom It May Concern:

I, Dr. Biju P R, herein referred to as the Claimant, hereby bring forth this notice regarding a dispute concerning an insurance claim under MEDISEP for the medical treatment of my father, P V Raju, herein referred to as the Insured.

The Insured, aged 68, was diagnosed with severe cardiovascular ailments necessitating urgent medical intervention. Subsequently, on 18 February 2024, he was admitted to MIMS Kannur Hospital where he received intensive care treatment, including two angioplasties and two angiograms, culminating in a total hospital expense amounting to 209000/-.

In compliance with the terms of the insurance policy, I, as the Claimant, promptly submitted all requisite documentation to the hospital administration to facilitate the processing of the insurance claim under MEDISEP. Upon submission, the hospital discharged the Insured, contingent upon the presentation of a bank cheque equivalent to the aforementioned hospital expenses, with assurances that the insurance claim would be settled imminently.

Regrettably, on 28 February 2024, the hospital administration notified me of a significant disparity between the approved claim amount and the actual incurred expenses. They stated that the approved claim amounted to only 89000/-, leaving a substantial outstanding balance. Moreover, they menacingly insisted upon immediate settlement of the outstanding balance, warning of repercussions if not complied with promptly.

Upon conducting due diligence on the MEDISEP website, it was discerned that multiple insurance package options were available, including one totaling 155925/- for IABP and angioplasty with two drug-eluting stents, and another package priced at 50800/- for PTCA, inclusive of diagnostic angiogram. It is evident that the approved claim amount egregiously deviates from the established insurance packages, thereby raising legitimate concerns regarding data manipulation or misinterpretation.

As the Claimant, I vehemently dispute the validity and accuracy of the approved claim amount and demand immediate rectification to reflect the actual medical expenses incurred. Furthermore, I denounce the hospital administration's coercive tactics in pressuring me to settle the purported outstanding balance under duress.

It is hereby requested that the complete insurance claim be expeditiously approved and settled in accordance with the terms and conditions of the insurance policy. Failure to adhere to this demand will compel the initiation of legal proceedings to safeguard the rights and interests of the Insured.

Sincerely,

Dr. Biju P R
Associate Professor of Political Science
Govt Brennen College
Thalassery