I was diagnosed with ckd in dec 2022 & got mediclaim paid(cashless)Since then I'm on dialysis for which the company pays the reimbursement on submission of bill..this time they're asking for history of ckd,hprtsn,etc..inspite of giving all details not processing the claim, stopping after 2 years of payment
Please carefully go through the terms and conditions of your medical policy regarding dialysis. There is nothing wrong if the insurance company is asking for certain details because CKD cannot be considered as normal disease. According to the doctor, how long you need to have the treatment? Whether the details submitted by you are by way of a certificate / letter by the doctor giving you the treatment? If yes, and if the terms and conditions contain dialysis treatment for any number of times, you may write suitably to the nodal officer of the insurance company requesting prompt payment of your claim amount. If there is no response for 30 days, or if your are not satisfied with the response, you may escalate your grievance to the insurance ombudsman in the state where you stay. If again you are not satisfied with the order of the ombudsman you may move to district consumer commission. You need not appoint any lawyer and can put the case on your own.
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