Dear sir,
I am employee of voith hydro Pvt limited noida, i have loged a mediclaim in the month of January’2010 from Paramount Health Services thru your service for my wifes delivery, we got this insurance card issued from our company, although i gave all papers subject to claim but i have not received any communication from your side nor the rejection letter. my PHS ID is UI NOI 20154669 VHPL
My mother took Senior Citizen Red Carpet Policy (Coverage: 2 Lac; P/161119/01/2009/000073) from Star Health. In 2008, when she took policy, she declared that she has Blood Pressure. In March,2010, multiple blocks in her heart was detected and accordingly she underwent open heart surgery. She spent around Rs. 260,000/- in this process. She submitted all the papers to Star Health. Today, I came to know that they have rejected the claim (#8713) and mentioned the reason “patient was symptomatic prior to inception of star policy”.
My mother felt cheated now as she paid hefty amount to these people in last 2 years and they rejected the claim when she really needs it. It looks like Star health Insurance is “only” interested in collecting the insurance (May be, this is the reason for selling it Cheap)?
What is the legal way to handle this issue ? Can anybody guide me ?
Ajay Goel
09840563293
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.
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.
Dear friends, never take a policy from star health. That is my experience. I have submitted claim No: 7320
in May 19,2010 and when ever i inquire about the status, they will say, we will call back and after that no response. I called them around 10 times and never got a response from them. Now i really got desperate and i feel that i will never get a refund from them. So i am planning to give a complaint against star health , trivandum, plammoodu office in consumer court. so never get in trap with star insurance hearing the sweet words of agents. a very very bad company.
Date: 12th Mar, 09
Office Of The insurance
Ombubsman
Chandigarh
Reg. Policy No. 361102/48/07/8500004631
Dear Sir
we have taken our mediclaim policy from M/S National Insurance COMPANY LTD. from last 4-5 years without any break.
Last year on very first instance, when I came to know the severe pain in my left kidney and I believe that due to some stone particles. This later on diagnosed by the doctors also. I immediately admitted to the nearest hospital i.e. Sarvodya Hospital on 27th May 2008. I was till there on 28th May 2008, therefore again for the same problem admitted on 31st May 2008 and discharged on 3rd June 2008 (the cashless approval was granted by Vipul for the said stay and whole treatment, which was not cured at Sarvodya Hospital). As the stone position in the kidney area was critical to operate there in the hospital, hence the hospitals officials called the doctors from outside for their valued opinion and after their mutual discussion, my family members were called and advised that since we do not have the sufficient machine / instrument to operate on that particular portion, where the stone is lying, advised my family members to take me to the Sharma Nursing Home, Faridabad, which has the expertise to resolve these types of critical cases, as they are having their in house facilities through their special and latest technology / machines for operating such types of critical cases.
Therefore, that was the time when we were not in position to even think more for any other option and proceeded as per the doctors’ advice. Upon these facts and position, I was taken and admitted by my family members in Sharma Nursing Home, Faridabad on 4th June 2008 and operated there and discharged in normal health condition on 9th June 2008.
At last I had submitted my claim for reimbursement of money spent by me to National Insurance Company and National Insurance Company refusal letter dated 22nd August 2008 came to me stated that the hospital where you have been treated, is not in our list of Hospitals.
Now, we are facing big problem for related to claim. National Insurance harasses us from last 7-8 months. When we have taken this policy there is not in hospital list. After when they do start limited hospital lists. They have not given us any information through courier or any source. . Every 3 months or 6 months they are changing hospital lists and give not any information to customer.
So, how can we update about it. Sir, right now we are in financial crises. We have gone to National Insurance at least 100 times form last 8 months. They have sent our case in their R. O. Office. They rejected also become of hospital. Our problem is genuine. We told them to check it out. But they harass us continue and misguide also. Please clear our case as soon as possible. They had already passed 40-50 cases as per our cases. Because some customers are relative of insurance Company’s employees. But they rejected our case without any reason. The Manager of National Insurance Mr. Kaul & Mr. M K Dhariwal have no answer about our case. They always said “your case is OK” But R.O. has rejected the file. They have advised us to go to R.O… We are already wasted our lot of time, Money and Fuel also. We are regularly disappointed by them. Now there is no way out to approach to you people. This is our humble request you to clear our case and make the Cheque of our Claim and our fuel expenses if it is possible.
Sir, my humble request to you is that please look in to the facts of case and kindly accord your approval, So that the reimbursement is made available to me at the earliest. I am again enclosing a copy of all mediclaim policies Photocopy and rejection Letter of Insurance Company for your ref.
Kindly take a necessary action immediately
Thanking You
Yours truly,
Jagdish Sikka
889/1, Raja Garden
Old Faridabad.
Encl.: as above
I got a call from Jeevan sahara for Mediclaim policy. They said that they will provide me mediclaim policy from United Insurance. I took it for my Mom & Dad & paid a crossed cheque of Rs.4750/- to person who came to my home to collect the documents. It’s now more than 25 days my cheque has been cleared but no documents received from Jeevan Sahara.
I hold a mediclaim policy with The New India Assurance Company for my mother.
Mem No.: 02I00257923B
Policy No.: 511600/34/08/11/00003362
My mother was admitted in AMRI Hospital, Kolkata for a surgery. The total Bill for the hospitalization was Rs. 1, 37, 825/-. On submission for “cashless” claim, the total permissible claim granted by “Medicare TPA Services (I) Pvt Ltd”. Kolkata was only Rs. 50, 000/-. Although the insurance cover for the above mentioned policy is Rs. 1, 50, 000/- with accumulated bonus of Rs. 50, 000/- for 1st 1 lac and Rs. 2, 500/- for next Rs. 50, 000/-
The logic given is that all expenses will be reimbursed basis permissible room rent. Now, if permissible room rent is Rs 1000/- and the actual room bill is Rs. 3000/-, then even surgeon fee would be reimbursed only to the extent of 1/3rd of the expense. Sounds pretty irrational.
I HAVE HAVING A MEDICLAIM INSURANCE POLICY WITH THE ABOVE MENTIONED COMPANY SINCE LAST MORE THAN 10 YEARS. MY POLICY NO. IS 230500/34/08/14/00005320. MY POLICY COVERS HEALTH OF MY FAMILY MEMBERS WHICH INCLUDES MY SELF, MY WIFE AND MY MOTHER. MY MOTHER IS AGED ABOUT 65 YEARS. I WAS HOLDING INSURANCE WORTH OF Rs. 25000/- ONLY BEFORE TWO YEARS. HOWEVER, BEFORE TWO YEARS I WAS COMPELLED TO TAKE AT-LEAST INSURANCE WORTH OF Rs. 50,000/-. NOW, I WISH TO EXCLUDE MY WIFE INSURANCE FROM THE ABOVE POLICY. BUT THE AGENT AS WELL AS THE COMPANY IS DENYING FOR EXCLUSION OF MY WIFE. I HAVE NEVER CLAIMED ANY AMOUNT ON HOSPITALIZATION OF MYSELF OR MY WIFE. I WISH TO CONTINUE MY POLICY WITH THE INSURANCE COVERAGE OF MY MOTHER AND MY SELF. IS THERE ANY WRONG? IS IT AGAINST TERMS AND CONDITIONS OF THE POLICY. CAN I CONTINUE MY POLICY EXCLUDING MY WIFE? PLEASE REPLY AT THE EARLIEST. THE PREMIUM IS BEING DUE ON 20-10-2009. THANKS AND REGARDS. FROM DHARMESH RETIWALA
I HAVE RENEW MY GOLD MEDICLAIM POLICY DATED 23′APRIL PASSED MORE THAN 20 DAYS NOT RECEIVED RELIANCE GENERAL INSURANCE.I HAVE COMPLAIN MANY TIMES BUT NOT RECEIVED COVRING LETTER MY POLICY NO :9202582825000023.
VERY BED SERVICE NOT HERE ABOUT THING.
Regards
Rajesh kodwani
Manager (IT)
PODDAR TYRES LIMITED
G.T.ROAD
LUDHIANA – PUNJAB – 141420