Jun 06, 2008 02:37 PM
4158 Views
Have taken a Daily hospitalization care policy in the name of My mother. She met with an accident & injured her wrist of the right hand. It was declared by the doctor that it is a fracture & requires surgery . She was admiited & was given the anesthesia to perform the surgery. The surgery done by the doctor was closed reduction of the fracture.
It was closed fracture which as per the policy is covered. The insurance company is now denying to pay the surgery charges & have just pass the claim for rs. 2000 as the hospitalization charges whereas the total expense on the treatment comes out to be Rs. 11000. I have taken up this issue with the insurance company they have declined to make the balance payment with the reason that this surgery is not covered in the Grade 1 surgery list. I have consultant the senior most orthopadecian of MAX hospital & taken his avice. he is also of the view that what is mentioned in the policy is same as treatment given & should be paid.
