Question
What is the name of your state? Arizona
My parents took health insurance from a leading Indian insurance company for three months to visit Europe.My father is a diabetic patient and due to excessive walking he got blisters on his foot.We approached the hospital for treatment of the blisters and then only we found out that his blood sugar was above normal.The doctor suggested immediate hospitalization for the treatment of his diabetes.The hospital expenses came upto 2000 dollars.The insurance company denied to pay this amount showing the following clause in the insurance policy as the reason 'Acute decompensation of diabetes *with the* (words between * added by the insurance company)begining of ulceration&blisters which has arised due to complications of diabetes.This entire Policy does not provide benefits for any loss resulting in whole or in part from, or expenses incurred, directly or indirectly in respect of any Pre-existing Condition.'The doctor's report says,''The blisters are due to extensive walking.Besides that, having diabetes made it necessary to take special care of these wounds to avoid worsening like ulceration.''We believe that
treatment of diabetes was compulsory for the treatment
of the wounds and the insurance must pay because it is
impossible to treat these wounds with high blood sugar.Even though we pointed out these to the
insurance company it denied to reimburse the hospital expenses repeatedly showing the clause in the insurance policy as the reason. Do we have a strong case here to fight
back with the insurance company to get our money back?
If so , how can we proceed legally to file a case ? Were there any similar situations which were solved legally and what was the result? Thnx
Answer
The answer has not changed since I answered it on another board a few days ago. If pre-existing conditions are excluded, then it doesn't matter how necessary the treatment is; it's not covered. You MIGHT be able to get treatment from the blisters covered IF you can completely separate the blisters from the diabetes.
No, you do not have a strong case.