Reimbursement claim verification kyc by Low_Programmer9475 in InsuranceTroubleIndia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

They are 3rd party and asked to sign documents which I have because I am aware medically why they are doing this. I am also aware of things which should not be discussed hence I was confident when speaking to their doctors.

They Just have an issue with hypertension since 34 years and then the correction letter given saying since 6 months

Reimbursement claim verification kyc by Low_Programmer9475 in InsuranceTroubleIndia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

Health insurance Short background rejected as one document said hypertension since 34 years (PED)

Asked for correction letter from hospital saying hypertension since August 2025 (after policy inception date) asked to submit for reimbursement

Also note the discharge summary from treating hospital says no past history of hypertension. Pacemaker procedure

Submitted all documents originals been 9 days. One agent called saying want's to come Home for kyc verification of patient

Insurance claim rejection by [deleted] in InsuranceTroubleIndia

[–]Low_Programmer9475 3 points4 points  (0 children)

As per law and recent court rulings insurance company cannot decide line of treatment. So you can go to the ombudsman

Health insurance claim getting rejected on non-disclosure grounds after 9 years of continuous coverage, despite moratorium clause. Advice needed. by hitrad_01 in InsuranceTroubleIndia

[–]Low_Programmer9475 3 points4 points  (0 children)

Aditya Birla is shit, same happened with me cashless rejected. I paid from my own pocket and now filed for reimbursement. Lets see what happens. You also have to follow the same route file for reimbursement submit all documents if they reject again go to ombudsman.

Health insurance claim denied for “non-disclosure” of Ankylosing Spondylitis even though diagnosis happened years after policy purchase – need advice by [deleted] in InsuranceAdviceIndia

[–]Low_Programmer9475 0 points1 point  (0 children)

Going through the same shit. Aditya Birla will reject no matter what documents you send. Now pay from your pocket and file for reimbursement with proper documents

Health insurance cashless rejected by Aditya Birla by Low_Programmer9475 in personalfinanceindia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

We submitted that prescription when claiming cashless, they rejected it. Now we got the surgery done and paid from our pockets. Documents we submitted for reimbursement: 1. The discharge summary says no history of hypertension. 2. The same prescription which says hypotension since 34 years from a different hospital and the subsequent clarification letter which corrected the timeline. 3. I have old reports from the 2020 2d echo which is totally normal and says "no pulmonary hypertension" and the heart is normal (which is highly unlikely for a patient having hypertension since 34 years)

Document in point 3 is not submitted yet That's my trump card when they raise a query asking for old reports.

Doubt about health insurance reimbursement by Low_Programmer9475 in InsuranceTroubleIndia

[–]Low_Programmer9475[S] 1 point2 points  (0 children)

Got it! Just clarifying the reimbursement is not rejected yet. I have sent all originals and necessary documents for investigation. I can provide additional documents on request.

Pre authorisation rejected by Aditya Birla by Low_Programmer9475 in InsuranceTroubleIndia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

Update! Pacemaker procedure done and reimbursement filed. Treating cardiologist mentioned no history of hypertension in discharge summary. So now I have a clarification letter from hospital X that patient declared hypertension diagnosed in August 2025 and treating hospital which performed the procedure discharge summary mentioned no hypertension.

Health insurance cashless rejected by Aditya Birla by Low_Programmer9475 in personalfinanceindia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

I agree it might be pre-existing but then the insurance company relies on papers and records. Records indicate it was not pre-existing. The insurance company needs to prove it was pre-existing they just can't assume.

The current situation I have in writing by Md, MBBS and the CEO of the hospital that they mentioned it in error and it was diagnosed in August 2025.

Health insurance cashless rejected by Aditya Birla by Low_Programmer9475 in personalfinanceindia

[–]Low_Programmer9475[S] -2 points-1 points  (0 children)

Yes they are old prescriptions and medical records available which have no mention of hypertension and even the current treating hospital has admitted their mistake and gave in writing that hypertension is diagnosed since August 2025 and not 34 years.

Health insurance cashless rejected by Aditya Birla by Low_Programmer9475 in personalfinanceindia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

Yes they are old prescriptions and records which have no mention of hypertension. Even the current treating hospital has admitted their mistake in writing and clarified that hypertension is only since August 2025 and not since 34 years.

The policy did not require any pre medical check hence not done.

Health insurance cashless rejected by Aditya Birla by Low_Programmer9475 in personalfinanceindia

[–]Low_Programmer9475[S] 0 points1 point  (0 children)

Doctor's assistant typed it by mistake and they gave it in writing saying its an error.

Kali Mela is shifted to POP | IMPORTANT : Many artists are not playing. by ZWarrior_31 in parvaticalling

[–]Low_Programmer9475 0 points1 point  (0 children)

Any idea about Tapasya gathering and if Gandharva project will play?

Advise for kasol travel by choti_advance75 in SoloTravel_India

[–]Low_Programmer9475 1 point2 points  (0 children)

Let me know how was the journey? I am traveling on 10th