MUMBAI: If you pay from your pocket for tests before a surgery, you are entitled to a refund from your mediclaim insurance company. This order favouring policy holders was passed recently by the state consumer commission. This includes expenses on an MRI scan done a month prior to the surgery, says the order. The consumer commission also specified that expenses incurred on consultation and pre-surgery tests cannot be refused just because the policy holder had spent the amount 30 days before the surgery.
The commission brought to book New India Assurance Company Limited for having rejected a reimbursement claim made by a Dombivli resident, V Sridhar. It pertained to pre-surgery and non-medical expense (gloves for medical use) incurred for his son’s knee surgery.
Sridhar’s son had been hospitalised on April 18, 2012. While Sridhar had claimed Rs 58,000, the insurance company approved around Rs 49,000. The commission’s order states that the company will now have to pay the entire claim of Rs 58,000 along with Rs 35,000 as compensation.
In his complaint, Sridhar had stated that the mediclaim policy covered his son, wife and himself for Rs 1 lakh. The complaint said that when he first submitted his claim, the company had agreed to honour it only to the extent of Rs 17,852. Sridhar said that when he made inquiries, the company agreed to reimburse Rs 30,856, but refused to compensate for expenses prior to hospitalisation and non-medical expenses.
