[Resolved]  Vipul Medcorp — Rejected medical claim from bams degree doctor in emergency situation.

Address:Pune, Maharashtra, 413102
Website:www.vipulmedcorp.com

Vipul medi corp rejected post claim by saying doctor degree was bams.

Reason of hospitlization: maternity

There is no any rule mentioned on there website
http://www.vipulmedcorp.com

While intimation i told doctor name/degree.
There is no such rule clearly mentioned to reject hospital claim of bams doctor, if this is the case then bams doctor should not get the licence/hospital id/registration no.

There is no such rule mentioned on
Rule no 9 in irda circuler and the indian medical council act.
-"recognised medical qualification" means any of the medical qualifications included in the schedules.

I submitted all documents including

1.Discharge form
2.Hospital total bill
3.Breakup bill
4. Medical reports
5. Medical bills with subscriptions.
6.Pre and post hospitalization charges.
7.Filled claim form, having doctor sign and hospital stamp with registration number of hospital

Mentioned bams doctor has hospital id, registration number and its own maternity hospital which is very famous in baramati area, there are very few hospital in baramati who having master doctors.
Hospital name itself is maternity hospital. Admission taken in this hospital in emergency situation.

Please help me to get claim pass
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Sep 18, 2016
Complaint marked as Resolved 
My Claim passed in the clause of emergency admission of patient so closing the ticket
Complaint comments 

Comments

Definition of Medical Practitioner(IRDA) is

12. Medical Practitioner
A Medical practitioner is a person who holds a valid registration from the medical council o f any state o f India and is thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction o f his license. [Insurance companies can specify additional or restrictive criteria to the above, e.g. that the registered practitioner should not be the insured or close family members].

===>

Given doctor name has registration number, this registration number is given by medical council. which is already shared with vipulmedicorp. obviously this doctor will not be illegal.

Given hospital name itself is maternity hospital, so they will have rights to do surgery as well.

There is nothing mentioned to not allow BAMS degree and you are trying to escaping claim by giving bull reasons. if this is case then this kind of hospital should get banned in india.


I insist corporate company to not buy insurance from vipulmedicorp for their employees. This is very bad experience from vipulmedicorp. this company's fools the people by explaining unknown and unmentioned policy's.

I am going to file legal case on vipulmedicorp.
I have sumbitted all the required documents still claim not passed by Vipulmedicorp, I am isisting corporate companies to not buy any insurance from vipulmedicorp

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    Baramati
    Maharashtra
    India
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