I am really thankful to you for your prompt attention to my msg about eyes treatment of my wife and ridiculously low ceiling on the amount of reimbursement under our Medi Claim Scheme and your assurance to take up the matter with the authorities at the appropriate time.
I give in detail the ailment and treatment being given to her whether this ailment can be covered under Clause-12 of Annexure-III of the scheme, because for every injection there is a short duration stay in the Clinic.
Initially, I consulted eye specialist Dr Aditi, who after examination carried out an OCT scan of the eyes and then advised that she is having WET ARMD WITH ONWARD OF GLAUCOMA ( Age related macular degeneration ) and we should consult a retina specialist, as she may need minimum three injections in both the eyes, one each at the interval of one month, and these injections can be given only by him.
I, therefore, consulted Dr D. Shroff, F.R.C.S., in the famous Shroff Eye Centre of Delhi and he diagnosed the ailment in medical terms as under:-
CHOROIDAL NEOVASCULAR MEMBRANE.—-BLURRED VISION
He gave the treatment as under:-
INTRA- ITREAL PROCEDURE FOR DELIVERING LUCENTIS INJECTION
In the Discharge Summary, it is shown as short stay. Full preparation like an operation was made and this injection was given in the Operation Theatre. After waiting for an hour, we were allowed to leave. The procedure of one injection cost me Rs 29,000/-.
ARMD is covered in Clause 8 at Page 13 of the Scheme with a ceiling of Rs 25,000=00 per eye per year, whereas total expenses for treatment in one eye including consultation, investigation etc will cost Rs 1,00,000=-, provided three injections are found O. K. after that on examination.Therefore, this ceiling of Rs 25,000=00 needs to be suitably raised. Otherwise it should be covered under Clause 12 of Annexure-III about hospitalisation for short stay as a specified procedure.
I would also like to bring to your notice the following requirement by MDI to process the claim for ultrasound test for the treatment of UTI:-
My wife is also suffering from UTI ( urine tract infection ). I consulted a Urologist in Fortis Hospital at Gurgaon, who prescribed ultrasound of abdomen (KUB)besides other urine tests and medicines. I got the ultrasound in PREMIA Medicare, and they charged Rs 750/-after senior citizen discount. I submitted claim for Rs 750/- and sent attested copies of prescription of urologist and ultrasound report with original receipt about payment by debit card. This cash receipt contains the details such as, name of patient and urologist, serial number and Date, test details, amount payable and paid etc and it is a computer generated receipt bearing stamp of the centre and signature. But yesterday I recd a mail from MDI that claim is under process but I have sent cash receipt only and not a Bill containing serial number, patient name, test carried, amount payable etc which is also required. Is it not an unnecessary requirement and causing harassment by MDI when all the details are already mentioned in the original cash receipt, which is quite comprehensive and how another bill will be helpful to settle the claim for such a small amount. I have sent them a reply by mail yesterday, which I am forwarding to you separately for your ready reference. I shall await their response to my mail in the next few days.
Thanks and regards,
S.R.Agarwal
Mob 08527571711
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