Status of Intimation No: CLI/2013/121111/0180774
 
 
 
Intimation No. CLI/2013/121111/0180774
Date of Intimation 15-02-2013
Policy-No/Adv Receipt No. P/121111/01/2013/005761
Policy-Issuing Office 121111
Product-Name: Family Health Optima -New
Insured Name: MR E JAYANTHAN RAMASAMY
Patient Name: E PUNITHAVATHY
Hospital Name: K.G. Hospital
City of Hospital COIMBATORE
Network/Non-Network Network
Date of Admission 06-02-2013
Field Visit Doctors Name Dr.Ramyadevi
Reason for Admission SINUS
CPU Code 950001
SM Code SH5301
SM Name L. R. SREE RAMKUMAR
Agent/Broker Code BA0000048472
Agent/Broker Name SANGEETHA S R
Hospital Code : Hos-0647
ID Card No : 2164792-2
Claim-No: CLM/2013/121111/179283
Registration Status: Registered
Provision Amount: 0
Cashless/Reimbursement: Reimbursement
CPU Code: 950001
Close Remarks
Reimbursement Converted Date : 27-02-2013
Remainder :
Remainder Date :
Ailment :
Status of Cashless :
Total auth amount : 0
 
Ailment :           CHRONIC RHINO SINUSITIS
 
TypeReceived FromDateAmountMedical Response Dt.StatusRemarksRemainderRemainder DateQuery
Reimbursement 1BO-COIMBATORE05-03-20138179013-05-2013RejectionWe have perused the claim records relating to the above insured-patient sent to us seeking reimbursement of hospitalization expenses for the treatment of chronic rhino sinusitis. Our medical team has observed from the K.G Hospital consultation letter dated 2.02.2013 that the insured patient has history of cough since 1 ½ years which is prior to inception of medical insurance policy. The entries regarding this has been tampered with and overwritten as 1.1/2 months.The present ailment of the insured patient is therefore a pre-existing disease. As per Exclusion No.1 of the policy issued to you, the Company is not liable to make any payment in respect of the pre-existing disease, until 48 months of continuous coverage has elapsed, since inception of the first policy with the Company. We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your claim. Yours faithfully, Authorized Signatory DV/-    Details
Reimbursement 2REJ RECONSIDERATION01-06-20138179003-06-2013Processed    Details
TypeBilling Completed DtBill Assessed AmtStatus 
Reimbursement 205-06-201364821Processed Details
TypeTypeDateAmountBankerType Of PaymentCheque/Transaction NoCheque/Transaction-DateFinal Rejection Remarks
Reimbursement 1Medically Rejected 0 Cheque  We have perused the claim records relating to the above insured-patient sent to us seeking reimbursement of hospitalization expenses for the treatment of chronic rhino sinusitis. Our medical team has observed from the K.G Hospital consultation letter dated 2.02.2013 that the insured patient has history of cough since 1 ½ years which is prior to inception of medical insurance policy. The entries regarding this has been tampered with and overwritten as 1.1/2 months.The present ailment of the insured patient is therefore a pre-existing disease. As per Exclusion No.1 of the policy issued to you, the Company is not liable to make any payment in respect of the pre-existing disease, until 48 months of continuous coverage has elapsed, since inception of the first policy with the Company. We therefore regret our inability to admit your claim under the above policy and we hereby repudiate your claim. Yours faithfully, Authorized Signatory DV/-
Reimbursement 2Approved05-06-201364821CLAIMS A/C - STANDARD CHARTERED BANKCHEQUE28871306-JUN-13