short amount of claim as per the rules & regulation of Policy

I have total submitted of total amounting to Claim of Rs.44837/-, but they have disallowed amounting to Rs.24085/- Kindly look into this matter and try to repayment above disallowed amount.

NON RECEIPT OF POLICY INSPITE OF REGULAR FOLLOWUP WITH M/s RAPID HEALTH CARE PVT. LTD

To,

The Hon’ble Magistrate ,
Consumer court,
New Delhi

Sub :Non Receipt of Policy inspite of regular followup

Respected Sir/Madam ,

My name is Ganesh Mal Joshi , Age 56 years is suffering from kidney problem has given to payment Rs. 12468 /- to M/s, Rapid Health care Pvt. Ltd. New Delhi through DD no. 003023 dt 19.04.2010 as premium for making Mediclaim Policy. I am the regular customer of Rapid health care (P) Ltd., Inspite of 18 – 20 times follow up till date they are not giving my policy , on every followup they say that your policy will come within 2 or 3 days.
I have deposite premium amount on 21 april 2010 & my previous policy has to be expired on 01 may 2010 ,I have paid my premium amount well in advance time .

My last Policy Detail are as under -:

Insurance Company – United India Insurance co. Ltd.
Policy No - 222700/48/09/41/00000481
Certificate no. - 3381
Advisor Code - RAP/0048
Covered w.e.f - 01/05/2009 to 30/04/2010

I have pending claim of approx Rs.150000/- , one of my claim I have submitted in Rapid Health care (P) Ltd. office on 28.06.2010 whose acknowledgement has kept in my records.
I have very disappointed to observe the service of M/s, Rapid Health care (P) Ltd. & feel difficult to do cure myself both mentally & financially.

Respected sir/madam you are requested to look into that matter & favour us my rights and justice.

Thanking you Addressof M/s Rapid Health (P) Ltd.
Yours failthfully Contact person -
Ganesh mal Joshi Mr. T.C. Chopra /Savita
410 Padma Tower – I ,
Rajendra Place,
My Address – New Delhi – 110008.
House no. 917 , (Ph.) 011 – 32222252
Sector – 21C , (M) 9811754804 .
Housing Board Colony ,
Faridabad ,
(Ph) 0129 2411227 ,
(M) 09811216884 , 09868855899
Email – snwvmpl@yahoo.co.in , vishvamktg@gmail.com

Non Responce For Claim

I have taken an health insurance policy from TATA AIG in june 2010 and on 29 june i have admitted in an 100 bed hospital due food poisoining and after discharge from hospital i am trying to contact those peopel for lodge of my claim but they are nither picking up my phone nor responding my sms and nor responding information given on their website, these people are just harrashing us at the time of booking of policy and force us for that and at the time of genine claim when then a person is suffering from his desease he also suffer for them………. shame on those insurance provider.v9 TATA AIG). please dont take any one policy from this company these are onlt cheater.

Reimbursement Not Being Done

Dear Sir,

I have taken One Family Care First Mediclaim Policy of Bajaj Allianz through Destimoney Company. My wife got major Intestinal Suregry in Jan 2010 and I have submitted claim for Reimbursement of Expenses against My Poliy No. 0121316756. My Claim No. is 03104021.

I have submitted all the documnets in original in the first file, Then I received a letter from TPA Mediacre to submit more documents which I have submitted. They are asking now the Original Recipt of Rs. 10,000/- from Jaipur Golden Hospiatl which is misplaced at their end only. However I went to Jaipur Golden Hiospital and requested them to issue me the Receipt once again. The Hospital has issued me the Duplicate Recipt of Rs. 10,000/- which is properly Stamped and Signed by the Hospial Authorities. I have submitted the Recipt to MEDICARe Patel Nagar Office. But now they have sent me a ltter that this Recipt is not Acceptable. They want original one otherwise they will close my claim.

Plrease let me know of once the original receipt got misplaced and even after submiiting the duplicate Receipt whioch is properly signed and stamped is submitted, then why they are not settling my Claim. This clearly indicates taht they are not willing toreimbure my claim.

Cashless Rejected Without Any Reason

Hello,

I was about to go through a laproscopy for endometriosis. The reason of the surgery was chronic pain in lower abdomen during menstrual cycles.
Earlier I was taking ayurvedic and homeopathy treatment as pain killers like meftal, meftal spas etc were in-effective for me.
In month of Feb-March 2010, I visited gynecologist in Deenanath Mangeshkar hospital and she advised me to go through laproscopy. For some personal reasons, I started the treatment with some other gynecologist from same department.
During month of June 2010, the endometriotic ceast size grew to 6 cm and it was urgent to do the surgery.
So I applied for my company’s insurance submitting all the required papers for cashless facility.
On the day when my surgery was going on, company/TPA sent rejection letter.
They gave the reason that they do not see any reason for admission.
I was admitted to hospital for 2 days and had 4 stitches. My surgery lasted for 2.5 hours and still the company says that there no reason for admission to the hospital.
Are there any doctors working in TPA? Do they really know anything about medical field?
We had to manage the money and pay the hospital bills of rs. 56000/-

I had similar incidence for my father’s treatment as well. He had hardaz disease, which affects your vision completely. By God’s grace, it was detected in earlier stage and he started with the treatment and recovering from it now.
He had to go through some expensive investigations and later on treatment costing around Rs.8000/-
He is retired from the service so Rs.8000/- is also a good enough amount for him.
He is also covered under my health insurance. So I claimed his medical expenses to same Oriental health insurance.
After 2 weeks, they rejected the claim saying “we cannot see any treatment given under admission. It looks to be mainly for investigation. All the medication is given after admission, which can be taken at home.”
I talked to my office agent and resubmitted the claim. But it got rejected again.

If in case of emergency, the insurance company is going to take us down then what is the use of paying so much premium every year?
We take help of medical insurance so our tension during hospitalization is only our dear and near one’s health and not money. But looks like these companies just find their way for not giving money, even though we pay premium regularly.

NON SETTLEMENT OF CLAIM

What do you need to know about claim procedure?

Having an efficient agent/broker who understands health and health insurance would be key in getting valid and correct claims documents to reach your TPA in time.

Call the TPA (Third Party Administrator) immediately you know about the hospitalisation schedule and within 24 hours of admission to hospital if it’s an emergency hospitalisation.

• Also write a mail or send a fax to the TPA or the health insurance company informing them about the hospitalization within the aforesaid time frame (this is because many health insurance companies recognize written communication only. You will also have a record of having provided the intimation.)
• The TPA or Health Insurance Company will provide you the intimation number through mail or sms but if they don’t, you must call them up and ask for the claim intimation number. This number is important for you to establish that your claim is duly intimated and is a helpful identity later in getting your claim processed and settled, so make sure you receive it.

For Documents Submission:

• Fill in the claim form provided in the company website or available with your Agent or Broker with details like your complete name, age, gender,  date of hospitalization, date of discharge, name of the hospital/nursing home, name of the medical practitioner, etc.
• Attach all the necessary claim documents (mentioned in policy wordings in the Claims Notice section) with the claim form and send it to the TPA or the Health insurance Company as mentioned in the policy within 7 days of from date of discharge, and get the same duly acknowledged with the time and date of receipt.

To read more see Health Insurance Claim Documents Submitted beyond 7 days rejected!

What is the time frame to submit claim document in health insurance?

Insurance Companies recently instructed TPAs to reject claims documents for which are submitted beyond 7 days from the date of discharge. So first, call the TPA (Third Party Administrator) immediately you know about the hospitalisation schedule and within 24 hours of admission to hospital if it’s an emergency hospitalisation. Instead of the 30 days window you could submit your documents, you now have just a week – which for someone who is working even 5 days a week, is almost like submitting the documents as soon as the discharge happens. This basically means you need to intimate claim within 1 day of admission and submit your claim documents within 7 days of discharge.

To read more see Health Insurance Claim Documents Submitted beyond 7 days rejected!

How to buy the best health insurance in India?

Most times, even Health Insurance agents desist from giving out full information in regards with a Mediclaim policy; the best option in times like this is to opt for a knowledgeable Health Insurance Broker! And here is what you should look out for while buying health insurance in India:

• Payment Options

• Network Hospitals                

• List of Exclusions

• Waiting Period

• Policy Sub-Limits

To read each in detail see Checklist for Buying Health Insurance

What is the checklist for buying health insurance?

In your search for an affordable health Insurance in India, there is a very high possibility that you end up focusing on the premium cost alone and ignore the other requisites such as waiting period, policy sub limits and so on.

• Waiting Period

Many Health Insurance Companies have a ‘Waiting Period’ when it comes to Pre existing Illnesses – Illnesses that the Insured had prior to buying the Mediclaim policy. The Waiting Period is mainly between 1-4 years, varying from company to company. One must remember to choose the Health Insurance Company judiciously, as in case of a change to another Health Insurance Company, the waiting period will be lost.

What to look out for: Health Insurance Companies that offer a lesser waiting period. (in terms of years when it comes to pre-existing illnesses)

• Policy Sub-Limits

It is important that you inquire about policy sub-limits before you buy the mediclaim policy as these sub-limits break the amount to be paid into smaller fractions wherein the Health Insurance Company bears some of the cost, while the insured bears the rest.

For E.g: Many Health Insurance Companies have a cap or a sub limit on the room rent, i.e. they will only an x amount for the room rent, while the insured has to pay the remaining.  

To read more such tips see Checklist for Buying Health Insurance