Sixty nine year old Sulochana Ben Bhavasar suffered a heart attack in Melbourne early this week while she was on holidays visiting her daughter and her family. She has been admitted in Holmesglen Hospital in Moorabin, Melbourne where she underwent a surgery yesterday to insert a permanent pace maker in her heart.
Even though the mother and her husband took out insurance from an Indian insurance company, yet, the company is refusing to cover the costs.
In his conversation with SBS Punjabi, Sulochana’s son-in-law Nirav said that the insurance company is looking for any and every excuse to deny the claim.
“Even though we have done everything right from our side, they are refusing to process our claim.”
Nirav’s in-laws had taken out insurance with The New India Assurance Co.Ltd, which was issued on the 27th of February 2017 for six months. Since the in-laws planned to leave Australia on 17th of November 2017, Nirav extended the insurance claim for another month.
However, after Sulochana Ben suffered a heart attack and they supplied the company with all necessary documents, the insurance company declined the claim saying that ‘policy does not cover pre-existing condition & its complication’.
Nirav told SBS Punjabi that he had contacted the third party authority (TPA) service of the company called Heritage Health regarding the issue and he only received one line response from them with no explaination.
After Nirav consulted the doctors regarding this issue, the doctors assured him that Sulochana Ben’s pre-existing conditions, namely Hypertension and Diabetes Mellitus, were not the cause of her heart attack and the two cannot be co-related. The doctors even provided written response to the insurance company.
Nirav believes that after the doctors ruled out pre-existing conditions as the cause of the heart attack, the insurance company changed its excuse to the fact that these conditions were not declared on the claim form whilst taking out the insurance in India. Nirav blames the agent who filled the forms on Sulochana Ben’s behalf for the mistake.
“All the forms are in Englsih. My mother-in-law does not understand English, even her signatures on the form are in Gujarati. It was the agent’s responsibility to check with her regarding her health as she knows she has diabetes. Instead, he just wrote ‘nil’ in every section,” he said.
Nirav believes that it is not the fault of his mother-in-law and that they have always openly declared everything. He said because his father-in-law is over seventy years of age, he had to get all medical tests done before he got the insurance and his conditions are also stated on his form. But because the mother-in-law was below seventy years of age, she was not required to do any tests and the agent didn’t bother to check as well.
“He didn’t ask any questions related to health. The same agent who issued the policy for my mother-in-law issued the policy for my father-in-law. But because he is 73, he had all the documents and test. But below 70 years of age, they don’t ask anything. They take no responsibility to even ask you the questions whether it is required or not.”
“Now the insurance company is saying that even though initially we declined the claim due to pre-existing conditions, not we are declining it because you did not declare them on the initial forms.”
The daily charges for keeping Sulochana Ben in ICU are $4,700. Apart from this, from the very first day of admission, she was fitted with a temporary pace maker to stabilise her, various tests were done and then yesterday an operation was done to put a permanent pace maker in her.
“All up, the hospital gave me an estimate of around $80,000 to $90,000 in expenses,” he said.
Even though it is a large amount of money, Nirav was full of praise for the hospital. He said that the Holmesglen staff did not pressure him to pay the money upfront and told him that he could sort out the finances later and that the focus right now was to make his mother-in-law better.
“I’m really thankful to the hospital. They are very cooperative. They have not pressured me about money till date.”
Nirav has paid an initial fee of $8,000 to the hospital and is now waiting to sort out the claim with the insurance company.
“They are very stubborn. They are now looking for any and every loop hole that they can find to avoid paying our claim,” he said.
However, Nirav is not giving up. He has contacted the Indian Consulate in Melbourne and has also written to the Foreign Affairs Minister in India complaining about the insurance company.
“Look I am not going to give up. It’s a lesson for all of us. I’m taking up the matter with the Indian Consulate in Melbourne. I’ve already sent communication to them and I’m attaching the claim form copies to Ministry of Foreign Affairs as well and will also cc the higher management of the Indian insurance company.”
Nirav said that he wants to make the Consulate aware that their Indian citizens are suffering overseas and instead of helping them it is the foreigners, the Australians that are helping us and trying to save the life of our mother.
“You are refusing to help, and the foreign hospital that has nothing to do with them because they are foreign citizens, they are doing everything possible to save her life,” he said.
SBS Punjabi has contacted the insurance company and is awaiting their response.
Friends have started a GoFundMe page to assist the family with medical expenses.
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