Milind Kharat, Insurance Ombudsman, Mumbai & Goa, has directed Bajaj Allianz General Insurance, to pay one of its customers the entire hospitalization expenses, barring non-medical items, incurred for Covid-19 treatment.
Abhay Chhapia, who had bought a health insurance policy from Bajaj Allianz General Insurance, with a sum assured of Rs 30 lakh, had availed of medical treatment in Mumbai based Wockhardt Hospital for Covid-19.
However, Chhapia had filed a complaint with the Ombudsman against short-settlement of a claim lodged under the policy by Bajaj Allianz General Insurance. He complained that a claim lodged for Rs 3.1 lakh for the treatment of Covid-19 (positive) undergone by him at Wockhardt Hospital was settled by Bajaj Allianz General Insurance on cashless basis with a deduction of Rs.1.3 lakh almost half the amount of claim.
He stated that he has been associated with the company for many years and further argued that he, as an individual, has no say or bargaining power in front of the hospital and had to pay whatever amount was charged to him.
After scrutinising the documents produced on record coupled with the depositions of both the parties, Kharat observed that the hospital has not adhered to Preferred Provider Network (PPN) rates and has overcharged the patient in violation of their agreement with the Bajaj Allianz General Insurance.
