Name of company/service: Souriau India Pvt Ltd
My claim for my Mother has been rejected by Mediassist TPA by saying the following reason.
My Mother has been hospitalized ( Malabar Institute of Medical Sciences-MIMS-Kozhikode) due to heavy disorder with diabetics and physical fitness, digestion problem etc..
Reason:-Supraventicular ventricular ectopics with Panic attack – admitted only for Investigation and test done are all within normal limits and current scenarioa is more likely due to psychosomatic rather than cardiac. Hence Claim denied under 4.10 and 4.8
Reason for rejection BY Medi assist India TPA ( Bangalore)
AS per discharge summary the insured is admitted to hospital for Supraventicular ventricular ectopics with Panic attack. As per records it is noticed that only Investigations done with out any active line of treatment during the period of hospitalization and test done are all within normal limits and current scenarioa is more likely due to psychosomatic rather than cardiac. All Investigations are day care procedures can be done on OPD basis and only oral medications are advised during admission period as symptomatic treatment. Hence claim stands repudiated under the Op Clause and 4.10 and 4.8 of the policy. We also reserve the right to repudiate the claim under any other ground/s available to us subsequently.
Objection against the rejection is given below –:
There is a mental aspect to every physical disease. How we react to
and cope with disease varies greatly from person to person.
For example, the rash of psoriasis may not bother some people very
much. However, the rash covering the same parts of the body in someone
else may make them feel depressed and more ill.
These are attitudes of persons cannot say that to psychosomatic disorder.
My mother doesn’t have psychosomatic disorder . but Of course she is having some anxiety about her health condition and disease. And I think it is normal of all person who crosses above the age of 65 yrs and are not physically well.
If any one who is very tried and feel very fatigued than usual days , what we will do normal, we will hospitalize the person, I also did the same with regarding my mother,
if she doesn’t took to much medicine means or drugs from hospital means she got some better health due to doctors care and also due to hospitality.
But that does mean that due to psychosomatic disorder she has admitted in hospital , and so you can reject the claim of patient.
If psychosomatic disorder should be claimed by psychiatrist/or doctor from the same hospital then you can reject the claim. otherwise how you can 100% predict the same.