Insurance company says hotel not hospital, denies Ahmedabad doctor Covid mediclaim

AHMEDABAD: An insurance company rejected mediclaim for Covid-19 treatment because the patient was admitted to a hotel and not a registered hospital. Following Covid-19 outbreak, the Ahmedabad Municipal Corporation had converted many hotels to designated Covid care centres to treat patients with mild to moderate Coronavirus symptoms to isolate them and curb spread of infection.

Having an insurance cover of Rs 10 lakh, the doctor has now moved the consumer court alleging unfair trade practice on part of the insurer. The doctor has consumer court to direct the insurance company to pay him his medical expenditure of Rs 45,119 with 12% interest along with Rs 15,000 towards compensation for harassment and legal expenditure.

The case involves a practising doctor Bhagyesh Shah, who was infected with Covid-19, and went to AMC-run SVP Hospital for treatment. As he was asymptomatic, the hospital referred him to a Covid care centre for isolation, observation and treatment. As Fern Hotel was designated a Covid care centre, the doctor preferred to remain isolated at the hotel so his family remained safe. The doctor paid a bill of Rs 45,119 to the Covid care centre for his treatment from May 3 to May 13.

He filed for medi-claim for the treatment bill with Tata AIG Insurance. On four occasions, the insurance company repudiated his claim on various grounds. One of the rejection grounds was that Dr Shah was admitted to a private hotel which does not fall under the definition of hospital.

Doctor cited IRDA circulars too

Dr Bhagyesh Shah argued that it was a designated Covid care centre with medical facilities available. He was referred to this facility by a public hospital and his discharge summary was signed by a doctor of SVP Hospital.

The insurance company also claimed that Dr Shah’s treatment cannot be considered treatment given to an indoor patient, but OPD treatment only. It also questioned the discharge report.

In his communication with the insurer, the doctor cited various circulars issued by the IRDA.

Source: The Times of India

http://www.insurancealertss.com//Insurance/Service/%20INDIAS%20BEST%20INSURANCE%20AGENT%20AWARDS%202020