CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE SR 207257

CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE SR 207257

Ms Meghna Dixit,
Administrative Officer(MRO III),
Health & misc (GPA )Deptt,
D .O. No, 120700,
New India Assurance CO.,
Mumbai.

    I have received your message dated 06-05-2019 under the above caption. At the very outset I would like to state that your said message contains factual error inasmuch  as it says that bills etc only Echo test is mentioned for which a payment of Rs 1,500/- has been made and there is no mention of Treadmill Test.

    I draw your attention to the Prescription dt 05-03-2019, Stress Echo Report dt 15-03-2019 and Hospital Bill Dated 15-03-2019. From the Prescription, you would observe that my Cardiologist has prescribed as STRESS ECHO ONLY IF RESTING ECHO IS NORMAL. From Stress Echo Report, you would observe that it consists of two parts, one Baseline Echo that is Normal or resting echo and other Exercise Stress Echo. From Hospital Bill, you would observe that it is for Stress Echo. Thus in none of these documents only Echo test is not mentioned, as stated in your message but stress echo.o

    I had thus undergone two echos, one normal or resting echo and another stress echo. The stress echo is always taken after exercise on treadmill machine. The hospital charged Rs 4,914/- after discount for both. The stress echo is not prescribed or taken straight away, as if a person has some cardiac problem, he may collapse on the treadmill machine itself and hence normal or resting echo is taken first to ensure that no abnormality has been found. The medical terminology differs from hospital to hospital and from doctor to doctor and it can not necessarily match with the terminology used in our policy. Our medi- Claim Policy is a welfare scheme and interpretation has to be in its true spirits. 

    Our policy provides as Echo Test Rs 1,500/- and TMT Rs 1,200/- and there is mention of Stress Echo. But there is no difference between Stress Echo and TMT, because Stress Echo is always taken on TMT. Thus the deduction of Rs 1,200/- is against the provisions of the medi-Claim policy, though terminology may be different. If you check up from any Cardiologist, he would opine that Stress Echo is always taken after exercise on Treadmill machine.

Please review the matter in its proper perspective and approve payment of Rs 1,200/-. Further I did not receive any response to my msg dt 10-04-2019 for almost three weeks from MD India inspite of a reminder on 17-04-2019 whereas these messages were addressed in the personal name of an official of the rank of AGM of MD India  with copies to your SDM Sri Paigankar. This is not the first time. Our experience is MD India officials are not sensitive and do not respond to the messages in a reasonable time. I  would also request that your office should impress upon M D India to be prompt in their response.

     Now I hope to hear from your end at an early date.

      Thanks,

S R Agarwal,
Retd Secy,
LIC, CO,
Mob 08527571711