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12. As per this clause, only hospitalization expenses for medical/surgical treatment at a nursing home/hospital as an indoor patient are covered (list of which is given). Thus, the only point for adjudication before us is whether the treatment taken by the complainant was required to be taken as an indoor patient or same could have been given as an outdoor patient?

13. The complainant has proved on record the discharge slip of SB Dr.Sohan Singh Eye Hospital Pvt.Ltd. dated 7.6.2009 as Ex.C-12 in which diagnose of the patient has been mentioned as "RAP STAGE 2" and operation conducted has been mentioned as "INTRAVITREAL LUCENTIS II UNDER LA". It is evident that during the course of admission, the complainant was administered Lucentis II Injection. He has further placed on record the certificate from the doctor of the treating hospital as Ex.C-11, in which it has been certified that the patient was suffering from RAP (Retinal Angiomatous Proliferans) a variety of CNVM in his right eye with visual distortion and visual deterioration. He was given an Intravitreal injection of Lucentis (an anti-VEGF agent) on 13.3.2009, an essential sight saving drug in these cases. It is clear from the certificate as well as from the Discharge Slip that the patient was admitted only to administer injection of Lucentis. The complainant had only paid for the cost of the injection and no hospitalization and other related charges as an indoor patient had been paid, which clearly shows that the hospitalization was not at all required for the purpose of administering this injection. The complainant has contended that a number of tests were carried out during the hospitalization but no such report of tests carried out, if any, has been placed on record to substantiate the averments. Discharge slip (Ex.C-12) shows that no reference to any test or investigation, required to be done, has been made during the entire period for which the complainant was shown as hospitalized. Under the heading operation, "Right Eye: Intravitreal Lucentis II Under LA", has been mentioned. It clearly indicates that no investigation or tests were required to be carried out and only an Intravitreal injection Lucentis II was given under local anesthesia in the right eye of the complainant. The opposite party has proved on record its circular dated 9.2.2009 (Ex.R-6), in which it has been specified as under:-

"For treating "Age Related Macula Degeneration (ARMD)"

under mediclaim policy, 2007, the drugs like "Avastin" or "Lucentis" or "Macugen" and other related drug is given as Intravitreal injection. It is an OPD treatment though this injection is given in the operation theatre. In view of the nature of treatment, it falls outside the scope of our health policies. Hence the treatment of ARMD with administration of above referred drugs or any other drug is excluded from the scope of the cover."

14. The treatment given to the complainant as mentioned in the Discharge Slip (Ex.C-12) and explained in certificate (Ex.C-11) of the doctor is fully covered by the circular (Ex.R-6) an same can only be considered as an outdoor treatment, which is not covered under the provisions of the policy. The complainant, being a doctor, has tried to bring the administration of an injection of Lucentis into the ambit of an indoor patient treatment just to obtain undue financial gain. Ex.C- 11 does not indicate if any other treatment was given to the complainant during hospitalization. It only states that Intravitreal injection of Lucentis (an anti-VEGF agent) was given on 13.3.2009 whereas the complainant has been shown to be admitted, as per discharge slip, since 11.3.2009. There is absolutely no record to show for what purpose the complainant remained hospitalized for 3 days. No medical record or bed-head ticket has been produced to substantiate the fact that hospitalization for such a long period was actually required.