Whether I can get reimbursement for Hernia surgery from Insurance Co?

Question

My son aged 23 years having some pains problem his right underscended. At that time I took him Dr , Dr infm me to take scan rt underscended Tests. After getting report I see the Dr, Dr examing the Report and advise me do a opeation immdly to your child. I asked what Operation, he infmed me Hernia Operation. Accordingly His advice I do Hernia Operation my child , now he is fine and claim my medical expenses incurred for my child to an Insurance Company. The Insurance Company rejected my Claim stating that Hernia is Congenital External Disease as per policy clause it is not covered. I infm them as oer Policy Pre-Existing Diseasea are covered. Kindly reimburse the same. The replied We have discussed the same with panel doctors also .
As per our panel doctors Underscended Testes is CONGENITAL
i.e since birth which has caused hernia.
Pre -Existing diseases are covered but congenital external
diseases are not covered. They replied like this. Kindly advise me in this .

Answer 1

Whether a pre-existing condition is covered matters only if the policy would ever cover that condition. If your policy excluded congenital conditions, it makes no difference whether it was pre-existing or not.

Your insurance doesn't cover congential conditions. period.

Appeal it to the state insurance department.

Answer 2

Congenital External??? I don't know who your plan is with.. I was 45 when I was diagnosed with a congenital blood disorder which I passed to my children, both of whom are employed and have their own insurance coverage.... NONE of the insurance carriers (and they are all different) have said a word about the CoaguCheck machine necessary for each of us to check our clotting factor. Each of our ins companies paid for each of us to haave one, and pay for the reorders on the test strips. A different company handles prescriptions for me.. I don't know about them.. but the anticoagulatioon meds that we take is covered by insurance.. and a blood disorder is definatley an internal congenital condition.

I don't understand how an insurance company can say that a hernia repair can be EXTERNAL. If it was unknown to you, then it should be covered as an undiscovered medical disorder. If as you say, pre-existing coonditions are covered and you knew about it, then you still should have covered.

You need to check your plan and maybe go to the Appeal board of your company.

Good Luck

Answer 3

check the insurance documents - if it's specified that congenital diseases aren't covered and your doctors themselves have said hernia is a congenital disease, then I'm afraid it's not possible to get reimbursed...

Answer 4

i should say u should better consult ur general insurance agent... i cant suggest u as i am a life insurance agent.. the only way i can suggest that if this disease was covered in ur policy check ur policy papers and u can go to Ombudsman where u make the complaints or to the consumer forum

Answer 5

You should make the insurance for all types of treatment including treatment due to any accidents also.Cove these--so that you will not face any difficulties for getting reimbursement.