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Insurance Company not paying for Surgery
Discussion in 'All Categories' started by Sikandar Baksha - May 30th, 2014 1:16 pm.
Sikandar Baksha
Sikandar Baksha
Dear Sir,
My wife was suffering from fibroid uterus with the severe bleeding. Doctor in Leelawati Hospital said for laparoscopic removal of fibroid. I dis that and surgery was performed. I was having TPA card of National Insurance company. When i deposited the bill of surgery to the insurance company they refused to pay the bill. They are saying that fibroid surgery you have got done for infertility. Please advice.
re: Insurance Company not paying for Surgery by ADITYA RAJESHWAR - May 31st, 2014 7:05 am
Dear Mr. Sikandar Baksha,

According to IRDA Medico Leal Manual clause 4.1 sub-clause ix, insurance company is not liable to pay for hysterectomy for hemorrhagia or fibromayoma or prolapse of uterus unless necessity by malignancy.

Hence you have to prove that the surgery performed was a necessity and was not done for infertility, it can be proved by the medical reports. If they still refuse to pay the bill then you have option to file a complaint to IRDA and to move an appeal to the consumer court.

Best Wishes

Aditya Rajeshwar
re: Insurance Company not paying for Surgery by Martn - May 31st, 2014 11:18 pm
Very Nice advice. Although why not you have taken approval before surgery. It was easy at that time.
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