News Update Insurance company refuses claim to COVID-19 patient, saying it...

Insurance company refuses claim to COVID-19 patient, saying it doesn’t need hospitalisation


New Delhi, Apr 9 (ILNS) With the second wave of Novel Coronavirus hitting the people hard, especially in the age bracket of 40 to 50 years, the insurance companies, although making big claims of covering the fatal disease, are not paying claims to the patients getting hospitalised.

The Star Health and Allied Insurance Co Ltd has declined the insurance claim to a 40-year-lady, who was suffering from COVID-19, saying that the deadly disease does not require hospitalisation.

The plight of the patient does not end here. Kailash Hospital, a private entity in Noida, refused to relieve the patient on the grounds that minimum five days course is mandatory for a chest infection due to the said pandemic.

The case pertains to a patient, who after experiencing high fever and difficulty in breathing, was admitted to Ram Lal Kundan Lal Orthopedic Hospital, commonly known as RK Ortho Hospital in Pandav Nagar, East Delhi on April 4.  She was immediately treated for fever, which was above 103 degree Fahrenheit.

During the stay of the patient, the local Hospital had conducted various tests on her, including ECG, X-Ray, Malaria, Dengue, Urine and Blood tests. The Corona tests, including RT-PCR and antigen, were also conducted. The reports of Coronavirus test, which came out the next day, declared the patient COVID Positive. Since the local hospital had no treatment for COVID-19, they told her to move to another hospital, which could treat her for the epidemic.

However, a bill of Rs 16,000 was raised by the hospital. Since the patient had a cashless insurance from Star Health and Allied Insurance Co, she applied for the claim. A sum of Rs 13,000 out of the total bill of Rs 16000 was reimbursed by the insurance company and the patient was relieved by the evening.

Anup Saini, a representative of the Insurance company, suggested the patient to shift to Kailash Hospital in Sector 27 of Noida, as the same was on the panel of the insurance company and it will be easier to claim the benefits. The patient was moved to Kailash Hospital for Covid treatment. The hospital was flooded with COVID patients. Seeing the over-flooding of patients, and the long waiting list for rooms, the patient decided to go home and follow the safety guidelines of quarantine there.

Kailash hospital conducted a few tests and allowed the patient to go home. Early next morning, her health deteriorated and she had difficulty in breathing, so she was rushed to the emergency ward of Kailash Hospital in Noida. The hospital accepted the cashless insurance by Star Alliance. The patient was treated very nicely by the hospital. On the third day, the hospital filed the claim from the company. To her surprise, the claim was denied, stating that the treatment of COVID-19 does not need hospitalisation.

The patient is mild symptomatic with mild vitals, maintaining saturation at room air, hence indication of hospitalisation is not convincing, said the company and denied the claim.

On the other hand, the Doctors claimed that treatment was mandatory and required hospitalisation of at least five days, which was very crucial for proper recovery. The hospital demanded a deposit of Rs 50,000 from the patient, who is still stuck in the hospital, with no money to pay. ILNS/SNG


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