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Hospitalization, Claims, ICICI Lombard

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  • Hospitalization, Claims, ICICI Lombard

    Hi,

    First, I would like to thank all the users for sharing their experiences/questions among the general public. It gives people like me more pointers on how to address the mess that I'm in currently.

    I live in the SF Bay Area. My parents are visiting me. They came here about a month back. We bought ICICI insurance in India with a policy max of $50K for each. Of course, I didn't read this forum before that!

    Unfortunately, my dad had severe chest pains on July 18th(2005) and I took him to the El Camino Hospital ER. They confirmed that he had a massive attack and immediately performed PTCA (Angioplasty with Stents) to remove the block in the artery. He spent a total of 4 days (2 in the Critical Care Unit and 2 in the Transition Care unit) in the hospital before he was discharged. The financial counsellor called me on the day of discharge and told me that the bill had already built up to $126K!!! She told me the following:
    * They don't recognize any Travel medical insurance.
    * They give 50% discount to patients who don't have insurance (and settle the accounts in the first 3 months)
    * I will be getting a detailed invoice, which might run to $140K or so within the next 5-7 days.

    I contacted ICICI and started the claims process as soon as my dad was admitted. I have sent them all the required documents (except a detailed medical report and the complete invoice since I don't have them yet). When contacted, ICICI says they'll get in touch with the hospital to get the report/invoice.

    Now, here are my questions:

    1. My dad (57 years old) has diabetes. Will this be considered a pre-existing condition for heart attack? I couldn't find any document from the net or otherwise to qualify it was a pre-existing condition. But it definitely puts you at risk as do obesity, age etc

    2. Does Transition Care Unit also come under Intensive Care Unit? The hospital rate for Transition Care Unit is close to $5000 and the ICICI insurance puts a sub-limit for each type of ward.

    3. Given that I'm pretty much facing a total bill of $150K, what are my options? I would like to know what should be used as a point of negotiation to deal with the hospital personnel. How do I ensure that I reduce the bill to the "right" amount?

    4. I'm definitely inclined to pay but even after a 50% discount, I'm looking at $75K. What portion of the $50K (max insured), do you think that ICICI will re-imburese, if at all? I would like to get a rough figure given your experiences. Has anybody got a re-imbursement at all from ICICI?

    5. Should I wait for ICICI to settle the claim with the hospital directly however long it takes? Would it be reported to the collection agency against my name if the payment gets delayed?

    6. What are my other options? Appreciate your thoughts.

  • #2
    It is difficult to predict for any of us how ICICI will handle your claims. Only they can give their best answers.

    I would appreciate if you could kindly post your experience once they process the claim or send any reply.
    Thanks & Regards
    Insubuy
    Toll Free: (866) INSUBUY
    Local: (972) 985-4400
    Fax: (972) 767-4470
    Website: http://www.insubuy.com

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