Scribd Logo
Upload

Welcome to Scribd!

  • 30 views

    Bharat

    Uploaded by

    ravi kumar
    The insurance company has rejected authorization for cashless treatment for the insured patient based on the following reasons: 1) As per documents, the patient has been suffering from the condition (implant removal) for over 2 years prior to obtaining the insurance policy. 2) The pre-existing condition was not disclosed during proposal of the first policy. 3) As per policy terms, claims for pre-existing diseases are not covered for the first 48 months. Therefore, cashless approval cannot be granted at this time for the reported diagnosis. The decision was communicated to the hospital and insured customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Bharat

    Uploaded by

    ravi kumar
    30 views3 pages
    The insurance company has rejected authorization for cashless treatment for the insured patient based on the following reasons: 1) As per documents, the patient has been suffering from the condition (implant removal) for over 2 years prior to obtaining the insurance policy. 2) The pre-existing condition was not disclosed during proposal of the first policy. 3) As per policy terms, claims for pre-existing diseases are not covered for the first 48 months. Therefore, cashless approval cannot be granted at this time for the reported diagnosis. The decision was communicated to the hospital and insured customer.

    Original Description:

    Congratulations

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The insurance company has rejected authorization for cashless treatment for the insured patient based on the following reasons: 1) As per documents, the patient has been suffering from the condition (implant removal) for over 2 years prior to obtaining the insurance policy. 2) The pre-existing condition was not disclosed during proposal of the first policy. 3) As per policy terms, claims for pre-existing diseases are not covered for the first 48 months. Therefore, cashless approval cannot be granted at this time for the reported diagnosis. The decision was communicated to the hospital and insured customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    30 views3 pages

    Bharat

    Uploaded by

    ravi kumar
    The insurance company has rejected authorization for cashless treatment for the insured patient based on the following reasons: 1) As per documents, the patient has been suffering from the condition (implant removal) for over 2 years prior to obtaining the insurance policy. 2) The pre-existing condition was not disclosed during proposal of the first policy. 3) As per policy terms, claims for pre-existing diseases are not covered for the first 48 months. Therefore, cashless approval cannot be granted at this time for the reported diagnosis. The decision was communicated to the hospital and insured customer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 3

    STAR HEALTH AND ALLIED INSURANCE CO LTD.

    ,
    SRI BALAJI COMPLEX,15,WHITES ROAD,CHENNAI 600014.
    Toll Free No : 1800 102 4477 / 1800 425 2255 , www.starhealth.in

    REJECTION OF AUTHORIZATION FOR CASHLESS TREATMENT

    TO, DATE : 23-DEC-2021

    HOSPITAL : Hyderabad Multi Speciality Hospital

    ADDRESS : 16-2-674/11, Judges Colony,Beside Hyderabad Kidney Centre


    HYDERABAD - 500036
    Andhra Pradesh

    Name of Insured Patient : MUMMADI MEENA Age / Sex : 49 / Female

    Date of admission : 24-DEC-2021 Diagnosis : IMPLANT REMOVAL

    Room category : Single Room A/C /Private A/C Product Name : Family Health Optima Insurance Plan - MED-PRD-
    100

    Policy Number : P/131127/01/2022/010623 Policy Start Date : 09-OCT-2021


    Claim intimation No. : CIR/2022/131127/3640922 Policy End Date : 08-OCT-2022

    Dear Sirs,

    We have scrutinized your request for approval for cashless treatment of the above insured patient for the diagnosed disease of
    IMPLANT REMOVAL.

    As per the documents received by us, the patient has been suffering from this disease/condition for the past 2 years which is prior to
    inception of the first policy. Hence it is a pre existing disease/condition.

    The insured has failed to disclose this in his/her proposal form at the time of inception of the first policy. As per the waiting
    period/exclusion no. Excl 01 of the policy, the claim for treatment of the disease/condition is not admissible until the expiry of 48 months
    from the date of admission 23/12/21
    We are therefore unable to consider the approval for cashless treatment of the above diagnosed disease.

    A letter addressed to the insured is attached. Please hand over a copy of this letter to the insured.

    Thanking you,

    Yours faithfully,

    SH064197

    23-DEC-2021 01:11 PM

    Authorized Signatory.

    IRDA Regn.No.129
    Corporate Identity Number U66010TN2005PLC056649
    Email ID : [email protected]
    STAR HEALTH AND ALLIED INSURANCE CO LTD.,
    SRI BALAJI COMPLEX,15,WHITES ROAD,CHENNAI 600014.
    Toll Free No : 1800 102 4477 / 1800 425 2255 , www.starhealth.in

    REJECTION OF AUTHORIZATION FOR CASHLESS TREATMENT


    DATE : 23-DEC-2021
    TO,
    MR.MUMMADI RAVI KUMAR
    H.NO:20-89 , KONDANDA , RAM NAGAR ,
    BACKSIDE SHARADA THEATRE ,
    DILSUKHNAGAR , FLAT NO:203 , S.V.
    SADAN
    -
    -
    Hyderabad
    Pincode : 500060
    Rangareddi
    Telangana
    Telephone : 9502645943

    Name of Insured Patient : MUMMADI MEENA Age / Sex : 49 / Female

    Date of admission : 24-DEC-2021 Diagnosis : IMPLANT REMOVAL

    Room category : Single Room A/C /Private A/C Product Name : Family Health Optima Insurance Plan - MED-PRD-
    100

    Policy Number : P/131127/01/2022/010623 Policy start date : 09-OCT-2021

    Claim intimation No. : CIR/2022/131127/3640922 Policy end date : 08-OCT-2022

    Hospital & Location : Hyderabad Multi Speciality Hospital, HYDERABAD, Andhra Pradesh

    Dear Customer,

    We refer to your request for approval for cashless treatment at the above referred hospital for the above diagnosed disease of the
    insured patient.

    As per the documents received by us, the patient has been suffering from the disease/condition for the past 2years which is prior to
    inception of the first policy. Hence it is a pre existing disease/condition and you have failed to disclose the disease/condition in the
    proposal form at the time of inception of the first policy.

    As per the waiting period/exclusion no. Excl 01 of the policy, the claim for treatment of the disease/condition is not admissible until the
    expiry of 48 months from the date of admission 23/12/21

    We are therefore unable to consider the approval for cashless treatment of the above diagnosed disease.

    Our decision to reject the approval for cashless treatment has been taken as per the terms and conditions of the policy issued to
    you. In case you are not satisfied with the above decision, you may represent to our Grievance Department at the following
    address:

    IRDA Regn.No.129
    Corporate Identity Number U66010TN2005PLC056649
    Email ID : [email protected]
    STAR HEALTH AND ALLIED INSURANCE CO LTD.,
    SRI BALAJI COMPLEX,15,WHITES ROAD,CHENNAI 600014.
    Toll Free No : 1800 102 4477 / 1800 425 2255 , www.starhealth.in

    Mrs. Radha Vijayaraghavan,


    Grievance Redressal Officer,
    Corporate Grievance Department,
    4th Floor, Balaji Complex, No. 15, Whites Lane,
    Whites Road, Royapettah, Chennai- 600014.
    (Land mark: In the lane next to Satyam Theatre Parking Area)
    Telephone : 044-4366 4600,Exclusive Number for Senior Citizen : 044-6900 7500
    E-mail id:- [email protected]

    Thereafter if you wish to pursue the matter further, you may represent to the Office of the Insurance Ombudsman whose address
    is given below:
    Office of the Insurance Ombudsman,
    6-2-46, 1st floor, "Moin Court",
    Lane Opp. Saleem Function Palace,
    A. C. Guards, Lakdi-Ka-Pool,
    Hyderabad - 500 004
    Tel : 040 - 65504123 / 23312122
    Fax : 040 - 23376599
    [email protected]

    Thanking you,

    Yours faithfully,
    SH064197

    23-DEC-2021 01:11 PM

    Authorized Signatory.

    COPY TO : Branch Office - Himayat Nagar


    STAR HEALTH AND ALLIED INSURANCE CO.LTD.
    1,3-6-111/8 and 3-6-111/9,3rd Floor,,Far East Plaza, Himayatnagar, Hyderabad-500029,

    IRDA Regn.No.129
    Corporate Identity Number U66010TN2005PLC056649
    Email ID : [email protected]

    You might also like