I have been a Health insurance policy holder of ICICI LOMBARD since February 2010. My wife and son are also covered separately. I have been renewing my policy regularly and continuing without any break by making premium. Therefore, in my case there is no waiting period of 2 or 4 years nor the clause of pre-existing diseases is applicable.
During my entire policy period from February 2010, God forbid, I have never fallen sick due any diseases and never visited any Hospital for treatment. I may have paid premium of ₹ 3.5 lakhs to ₹ 4.00 lakhs without availing any medical assistance during this 10 years period. I was having health problems due to less Haemoglobin and undergoing treatment with a private hospital from 08/06/2020.
On 13/06/2020 at around 01.43 AM I was rushed to Fortis Hospital, Kalyan as suddenly I vomitted and felt very uncomfortable as I had slight giddiness. I was checked by RMO and admitted after completing registration process. Next morning 14/06/2020 I was checked for Covid-19 and my Report showed NEGATIVE. My regular treatment for Anemia started. As I am already covered under Health insurance policy of ICICI LOMBARD, I submitted all the details of my insurance policy documents after admission for opting Cashless claim. The hospital authority submitted all the relevant details of my policy and asked for Initial payment as Advance. The amount was approved for ₹ 10, 000/- on 14/06/2020. Again on 15/06/2020 Hospital sent request for enhancement of amount, again the amount was approved for ₹35K. So there was no any problem and payments were released as per the insurance policy terms and conditions.
My medical treatment continued till 18 June, 2020. On the day of discharge 18/06/2020 the hospital submitted the final bill after deducting the advance received and balance receivable from ICICI LOMBARD was around ₹ 70-80K. Fortis Hospital got the approval from ICICI LOMBARD and accordingly discharge formalities were completed and I was released from hospital at around 5.30-6.00pm on 18/06/2020.
Surprisingly and shockingly I received call from Fortis Hospital that ICICI LOMBARD have rejected the final amount of Bill, although was previously approved and hospital gave discharge based on the approval. Hospital had no idea why the final bill was rejected by ICICI LOMBARD nor there was any reply to our query. I was just relaxing and taking rest after discharge. But the call from Hospital saying the entire cashless claim has been rejected and I had to pay to hospital ₹ 1, 27, 000/- immediately again made me breathless, shocked, mentally tortured and physically disturbed. I am a Retired man how am I to arrange and make payment to hospital.
I wrote emails so many Tweets, several phone calls to ICICI LOMBARD to give reason/grounds for rejecting the claim.
Finally, ICICI LOMBARD might have realised that it is their fault, negligence, and mistake they finally cleared the final bill to hospital. Hospital confirmed that the final bill approval has been received and I have nothing to pay.
I am drafting out case papers to file and claim damages from ICICI LOMBARD for mental harassment and deficiency in service for ₹ 2.00lakh. I am filing the cases with supporting’s , voice recording of telephonic talk, all relevant documents with Consumer Court & IRDA.