Denial of health insurance claim on dubious ground.
Before getting cataract surgery at a network hospital in B'lore I sought prior approval from the TPA viz.,Mediassist India for cashless facility as required. Though the facility was denied on ground of "break in policy", I was distinctly advised on 07/4/16 through the hospital authorities with the following in bold words: "Denial of Cashless Facility is in no way construed to be denial of treatment.The Patient may obtain the treatment as per his/ her treating doctors advice and submit the full claim papers to us for possible reimbursement subject to admissibility of the claim as per terms and conditions of the policy".
Accordingly, I got the surgery spending Rs.33000/-getting sure that the same ground would not be applied in rejecting the reimbursement claim. Because, had it been so, I'd not have been advised to submit the reimbursement claim at the very first instance.
But surprisingly enough, my reimbursement claim was also rejected on the same ground; and despite my complaint/ appeal to the insurer Oriental insurance co it was neither reviewed nor properly addressed to.
Please advise can the insurer apply the same ground after their communication dt. 07/4/16. Was not it an inducement to incur "known non-reimbursable" avoidable expenses? Was not it misguidance on the part of the TPA/insurer when advice was sought in good fath and also acted in good faith by me? Should I move the consumer court to get justice?
As health insurance claims are rejected in plenty on some pretext or other, I wish to get your co-operation on legality of this denial.