Reasonable & Customary Charges

Reasonable & Customary Charges

Prasad’s reimbursement bill for Rs. 27,000 had been rejected.

Prasad had been diagnosed with a Chronic Respiratory Disorder.

He had undergone a 6 day hospitalisation and was advised Oxygen Support for about 60 days post discharge.

Already in a devastated state of mind, he bought an Oxygen Concentrator without a second thought.

What Prasad failed to recognize was the fact that his mediclaim policy which covered everything from Day 1 did not cover instrument charges.

And therefore the Insurer would not reimburse him for the Rs. 27,000 he had spent on the Oxygen Concentrator.

But, we were the intermediary in Prasad’s policy.

What Prasad did not know was the fact that though the Insurer might not pay for instrument charges, they were liable to pay for any servicing charges that might be levied for upto 60 days under post hospitalisation expenses.

We fought with the Insurer to consider the expense incurred as a rental one and therefore a servicing charge as opposed to an instrument one. And that is how we helped Prasad claim for a reimbursement of Rs. 9,000 under post hospitalisation expenses.

Agreed, it was a long battle. A lot of email exchanges with the Insurer & the TPA. But that is who we are. We understand the policy terms and conditions like the back of our hand. And service excellence is our middle name.

So, who do you have by your side?