Trending @Infosys; My Mediassist claim has been rejected
Hi, Few weeks back I met with an accident and my one toe bone was fractured and I got multiple wound dressings from hospitals, i got one X ray scan from Dr Pathlab. I applied for Mediassist claim but it was rejected with below reason, can anyone please tell why it was rejected.
I guess Medi assist will pay if you are in hospital for atleast 24hrs
Correct.... Claim only approved for hospitalization (atleast 24hrs) and also read the OPD benefits under the coverage ( INCLUSION & EXCLUSIONS)... Usually In corporate insurance claim rejections won't happen unnecessarily.
Don't depend on the insurance provided by Infosys. I had admitted to the hospital recently for a surgery and the hospital quoted 65k for the insurance claim. Out of which only 35k was approved by the insurance company and I had to pay 30k out of my pocket to get discharged.
So, I suggest everyone who's reading this not to depend on the insurance provided by Infosys. Take private insurance with more cover, I took 1 Cr cover in my case keeping 40 long years ahead in mind.
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It seems you are claiming OPD chagres which is not covered in insurance . You should be admit into hospital atleast for 24 hours
It's health insurance, it won't cover accidents. This comes under personal accident since you have told your toe bone is fractured, try if you're able to claim Temporary disablement. High level, Health insurance is not for accident and even for health scenario OPD comes with certain level of premium tiers you need to check the coverage landscape of your insurance tier like gold, silver, titanium etc.
Go through the policy terms and conditions once if you think your claim is valid contest this decision. Most probably they will pass the claim. This is common practise of every health insurance company to reject claim on first glance or pay only some amount for dubious reasons.
Reading this i thank god to give me wisdom and went with mediclaim outside
