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Religare Health Insurance — genuine claim got rejected after giving all the proofs

My name rameahwar kushwaha - client i'd 58108762 and member id no 00000zs062.
Claim no. 90778783 against your health insurance policy no. 11826200.
Total amt 60k got rejected on 26 dec-18 and i have submitted the claim document on 22 november-18.
Reason _ this patient can cure on opd basis.

When my wise having unbearable pain and became unconscious that's why i have hospitalised and spend money from my pocket. I have also sent dr. Letter for hospitalised justification. But still they have rejected and not listening me.

Please help in getting reimbursement of the same.

Looking forward your support.

My name rameahwar kushwaha
[protected]
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Complaint Status


[Jan 27, 2019] Religare Enterprises customer support has been notified about the posted complaint.
Updated by Rameshwar Prasad Kushwaha Jan 27, 2019 Hospitalised justification letter

Updated by Rameshwar Prasad Kushwaha Jan 27, 2019 Hospitalised and discharge summary

Updated by Rameshwar Prasad Kushwaha Jan 27, 2019 Discharge summary
Complaint comments  1 Comment     Updated: ShareTweet

Comments

Hi, Health insurance is meant for helping financially to insured in critical times that is suffering from illness requiring hospitalization for more than 24 hours, but not for rejection. It may be noted that thought Opd treatment is not covered in any health policy, all hospital treatments are not of opd ones, in such cases it is not enough to say particular treatment is opd one, no claim can be allowed unless documentary evidence is provided for in writing.
in most cases treating doctor is deciding hospitalization depending on nature of disease. In case of insurer has not settled the claim, you may approach insurance ombudsman, where in decision will betaken whether contention of insurer is right or wrong based on documents provided by both the parties.

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