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surgery claim rejected after Pre-authorization was first approved
07-May-2023 (In Insurance Law)
Pre authorization was approved for surgery at least 1 week before the surgery. Based on that approval i had gone ahead and had the surgery.The insurance (religare) rejected the claim when hospital submitted the discharge summary saying sleep apnea is not covered in the insurance. According to insurance, the medical code used by the hospital for pre authorization was covered but the medical code in discharge summary was for sleep apnea hence they cannot pay. Can i sue Insurance or should i sue the doctor and the hospital or all 3 for misleading me to get the surgery? I may not have opt for the surgery now if i knew it will not be paid by insurance. This has caused me financial distress as i was not prepared for the 1.7L medical bill.
1. After referring the corporate religare terms and conditions, In the clause of waiting period 4.1.b(i) the disease that you mentioned is covered after 24 month of policy availed date.
2. You can issue legal notice to religare for the treatment settlement, else you may sue them in consumer court.
2. You can issue legal notice to religare for the treatment settlement, else you may sue them in consumer court.
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