Simplest Guide for Health Insurance in India

To,
Honorable Consumer Court

I, Asad Husain S/o Late Zahid Husain, R/o Yamuna Vihar, Delhi-110053, I hereby serve complaint upon the following reason:
1. That the representative of (RGI) Reliance General Insurance (Mr. Rajkumar) visited my premises and requested me to avail RGI mediclaim policy. I acceded his request and accordingly opted for a mediclaim policy for the period 01.04.2008 to 31.03.2009 vide policy bearing no. 282550051984 dated 02.04.2008.
2. That on 24.02.2009 at around 8:45 pm, I was returning to my Home from my office situated at Faridabad with my colleague (Virti Shrivastava) by my bike make Pulsar bearing Regn. No. DL7 ST 8866, while reached to Okhla Mor I suddenly lost my control on my bike and fell down on the road due to the bad conditions (Pits and holes) on the roads which were not seen as there was water logging on the road.
3. That immediately thereafter, I and my colleague was taken to nearby Hospital (Holy Family Hospital) by some passersby whereupon after conducting my tests/ checkups the doctors found that my left arm is broken and steel plate will have to be fix by way of operation and thereafter they admitted me for treatment.
4. That the officials of Holy family Hospital asked my brother (Amjad Husain) to deposit money for my treatment who had reached to the hospital as he was aware that I have above mentioned policy therefore, he presented my mediclaim card for cash less treatment but the officials of the hospitals refused to accept the same stating that that we are not in the panel of this company. Thereafter, my brother contacted to RGI’s authorized TPA’s (E-Meditek Solutions) customer care.
5. That TPA’s customer care executive advised my brother to take the treatment in the same hospital and asked him to submit all the bills of treatment to TPA after my clients discharge. Customer Care Executive also assured that all the bills will be reimburse by RGI and entire claim will be settled by RGI. Accordingly, he deposited the money with the hospital.
6. That on 25.02.2009 one Policeman visited the hospital and recorded my statement and thereafter I was operated and discharged on 27.02.2009 from the hospital.
7. That after some time as I was on bed in ridden condition, on 17.03.2009 I submitted all documents/bills to TPA. After one week TPA demanded me to submit some more documents to settle the claim and accordingly I submitted the same documents on 27.03.2009 as per TPA’s requirements.
8. That thereafter I contacted TPA as well RGI and inquire about the status of my claim, to the utter shock and surprise of me, I was replied by TPA’s Customer Care Executive that claim was rejected. When I asked about the reason of rejection he disconnected my phone.
9. That on 13.04.2009, I sent an email and repeated my request with regard to the claim. In response to my email I received an email on the same day sent by RGI’s customer service team.
10. That on 14.04.2009 I again sent an email to Ms. Shubhra Tyagi/Mr. Brijesh Sareen and again requested to settle my claim. In response of the same TPA issued a Repudiation Letter dated 14.04.2009 thereby stating that as per discharge summary, patient has been admitted in the hospital on 24.02.2009 but certified copy of from the police station states that patient had the accident on 25.02.2009. Thus, there is a gross variation in the narration of accident. Hence, the claim cannot be settled. The rejection of the claim is shows mollified on your part and the same is apparent with the fact that I had submitted the certified copy of DD Entry bearing no. 25 A dated 24.02.2009. Mere perusal of the DD No. 25 A transpires that the information with regard to the accident is received in the Police Station at 9.00 P.M. on 24.02.2009. However, my statement was recorded by the police on 25.02.2009 vide DD No. 688 dated 25.02.2009.
11. That TPA mollified and illegally rejected my claim by way of manipulating the facts that the accident was occurred on 25.02.2009 and treated the date of recording of statement as date of accident.
12. I kept on writing various email in this regard and also visited personally TPA office, Gurgaon. On 04.05.2009 I received an email sent by Shubhra Tyagi, from RGI Health Claim Department thereby informing that the discrepancy has been waived off under the said claim and TPA has been recommended to process the claim on merits of the same.
13. That I kept on waiting for the response to TPA’s side finally on May 13, I sent another email to Shubhra Tyagi to which I was replied that my claim has been rejected and repeated the same thing that as per discharge summary, patient has been admitted in the hospital on 24.02.2009 but certified copy of from the police station states that patient had the accident on 25.02.2009. Thus, there is a gross variation in the narration of accident. I called many times to Shubhra Tyagi but she was not picking my call. Then on 14.05.2009 I sent another email to said Shubhra Tyagi and protested against the rejection of claim.
14. That I received another letter dated June 16, 2009 for clarification with regard to the contradictions in the discharge summary/MLC of the hospital and certified copy of Police reports. In response of the same I have already clarified that I have not told the reason of accident to the hospitals officials as they have written the reason of accident that my bike was hit by a car. I don’t know who has given this information to the hospital’s official as I was not proper state of mind at the time when I was brought to the hospital. The and the statement of mine was recorded on 25.02.2009 and it was the Police to whom I stated the reason not the Hospital Officials and even on the MLC also there was no where written that the reason of the accident was told by me to the Hospital officials. In the MLC itself it is written that “ALLEGED” to hit by a car. That since the information to the Hospital officials regarding reason of accident was not confirmed and was wrong. Therefore, I should not be suffering for the mistake/fault committed by the Hospital people.
15. That RGI have itself stated vide Shubhra Tyagi’s email that discrepancies with regard to the claim have been waived off and therefore, no question should be arise for rejection of my claim by way of taking the same ground again.
16. That due to RGI and TPA’s above said acts and activities I am suffering not only in monetary point of view but mental harassment also.

Please, you are requested to take an action against RGI and TPA regarding my claim on base of above said statement. Please settle my claim because I am very frustrated.

Thanking you

Sincerely yours

Asad Husain
(Claimant)

I have purchased a Reliance Medical insurance policy floater plan for my family on 19 Dec 2009 from site [url=http://www.reliancegeneral.co.in]Health Insurance, Car Insurance, Home Insurance, Travel Insurance, Business Insurance – Reliance General Insurance[/url] and paid amount by Net Banking. They have debited amount from my account on same day same time but after that, they does not provide my policy number. I got my policy number after talked to customer care and sent a mail to [email]services.rgicl@relianceada.com[/email] now My policy number is 9202792825019606.

Regularly I talking to customer care from same day after some time they opened a customer ticket with No. 853006, and tell me give 72 hours for resolution but I am not getting (policy cards and documents) any solution, regularly they escalate a ticket and never provide a solution to me, one time they told me, documents were sent by Professional courier with AWV No 404818123, I cross checked it with Professional courier offices in Mumbai, Delhi and Noida but No courier available there.

Still I am not getting my documents so please provide the best solution to me…

Dear All,

This entire Harassment session is going on from last 5 months.

1. During the last week of May 2009 we have submitted the duly application of mediclaim policy of my father and mother (for a sum insured of Rs. 500000), along with all the documents required and cheque to the agent Mr. Manoj Agarwal from Reliance General Insurance. Then he informed medical test has to be conducted as my father is of 60 yrs and my mother is 50 Plus.

2. We did the medical test which was clear and so waited for policy as we were informed by Mr. Manoj Agarwal that he will collect the medical test result papers from the doctor.

3. After few weeks when we haven’t received the policy we called Mr. Agarwal, and then he informed that medical reports are pending, so i collected from doctor and submitted to him, though he earlier told that he shall collect the medical reports from doctor.

4. By now we again asked him that there is nothing pending from our side which he confirmed and committed that the policy will be received by us within 2-3 weeks.

5. Based on his commitments we again waited for 3 weeks. But still we haven’t received the policy and called Mr. Agarwal, by then he gave one more excuse that the premium amount has changed you have to issue a new cheque.

6. Then i transferred him the premium amount stated by him t his ICICI Bank account instead of issuing new cheque on 08/09/2009 (Amount transferred Rs. 6794/-)

7. Post that again few more weeks passed still we haven’t received the policy and he was not responding to the phone calls.

8. Finally we contacted the branch manager then he informed that his branch hasn’t received any application which as a applicant was not our fault, as we have submitted all the required documents and the payment to their representative.

9. Then finally we signed a new application form and received the soft copy of policy today. But we have applied and committed for the sum insured of Rs. 500000 which i mentioned earlier, aslo the premium receipt shows the paid amount as Rs. 5459. There is a difference of Rs.1335.

Now we realize this is nothing but a fraud and we are going through tremendous mental harassment in following up with all the stake holders.

Regards,
Vikas Kulkarni.

I have under gone surgery for removal of stone in kidney.

I spent around Rs. 1.50 Lakhs.

I was covered by Reliance General Insurance vide master policy number 12/28/12/00044/05 and Certificate No. AH3/VB000000193. Please help me to lodge my claim.

Really I am pained not due to surgery but for the troubles
I am facing to lodge my complaint.

How can we trust private insurance companies?

Whether Public enterprises also do the same?

If so what is the use for the insurance policies?

I do not know English and I am almost an illiterate.

Some one sold the policy to me. Now I am requesting
every body to help me to get my claim.

Regards

G.ANNAPURNA

I have a Corporate Medical Insurance of Reliance General Insurance through 3rd Party Paramount Health Services,

My (Kumar Sudhir) PHS ID is : RG NOI 12175693 JAL
Wife (Anju) PHS ID is : RG NOI 12175694 JAL
Daughter (Mansi) PHS ID is : RG NOI 12175695 JAL
Daughter (Jihi) PHS ID is : RG NOI 12175696 JAL

I have submitted my claim form of my wife (due to her severe illness and I had to rush to the nearest hospital which is not network hospital) through my company’s HR in December 2008, but still there is no any response.

One day (on 29.01.2009 at 17:53:40) I called customer care help desk at 022-66620808 and got response that “PHS needs the authority letter from the hospital to verify the documents” and the letter is issued from PHS Delhi office to our HR but still I didn’t received any letter.

Important Note: On website www.phmhealth.com and also the booklet provided didn’t mentioned that PHS needs any authorization letter to verify the hospital document. if they need to verify go directly to the hospital and verify it. I do not have any problem.

Another thing also that your website does not contain any email address in contact us section. There is address, Phone number, Fax number only.

I am holding Reliance Health wise Policy number 282520115946 had paid yearly premium to my agent Shri H Rathod on 1st July’09 (Policy lapse date 6th July’09). The cheque was of HDFC bank, Mulund branch bearing a number 522546 dated 01/07/2009 for Rs.1121/=.

In spite of repetitive reminders to Reliance General Insurance (RGI), the cheque is not yet presented to my Bank and still the whereabouts of the cheque is not known.

I contacted Customer Care Dept of RGI, where I was told to contact the Nariman Point branch (Code no. 1101) to know the status of the Cheque and the telephone number given to me was not in existence!!! WHAT A GREAT CUSTOMER SERVICES!!!

With this complaint letter mail, I want to point out such a discrepancy in the services of RGI where the customer is unnecessary gets harassed and the Customer care department itself does not have full information about the prime branches of Reliance General Insurance.

The same was registered at customer care services, but no response from them. My complaint number is 454102.

With a hope that Policy will not lapse,

Rajesh M Shah
(M) 9967551441

I took a Mediclaim policy (Policy No. 282510402313) from Reliance General Insurance on 1st July 2009 but still I don’t receive any policy documents at my address. I have complaint twice to their customer care center for this matter but the result is nothing.
I don’t why this big company is doing such a fraud to the customer. Once, they receive the premium from customer, they should deliver the policy documents which 15 days. But, I am still suffering for this. I need my policy document at my address otherwise the company should refund my premium amount back to me.

Dear All,

This entire Harassment session is going on from last 5 months.

1. During the last week of May 2009 we have submitted the duly application of mediclaim policy of my father and mother (for a sum insured of Rs. 500000), along with all the documents required and cheque to the agent Mr. Manoj Agarwal from Reliance General Insurance. Then he informed medical test has to be conducted as my father is of 60 yrs and my mother is 50 Plus.

2. We did the medical test which was clear and so waited for policy as we were informed by Mr. Manoj Agarwal that he will collect the medical test result papers from the doctor.

3. After few weeks when we haven’t received the policy we called Mr. Agarwal, and then he informed that medical reports are pending, so i collected from doctor and submitted to him, though he earlier told that he shall collect the medical reports from doctor.

4. By now we again asked him that there is nothing pending from our side which he confirmed and commuted that the policy will be received by us within 2-3 weeks.

5. Based on his commitments we again waited for 3 weeks. But still we haven’t received the policy and called Mr. Agarwal, by then he gave one more excuse that the premium amount has changed you have to issue a new cheque.

6. Then i transferred him the premium amount stated by him t his ICICI Bank account instead of issuing new cheque on 08/09/2009 (Amount transferred Rs. 6794/-)

7. Post that again few more weeks passed still we haven’t received the policy and he was not responding to the phone calls.

8. Finally we contacted the branch manager then he informed that he is branch haven’t received any application which as a applicant was not our fault, as we have submitted all the required documents and the payment to their representative.

9. Then finally we signed a new application form and received the soft copy of policy today. But we have applied and committed for the sum insured of Rs. 500000 which i mentioned earlier, also the premium receipt shows the paid amount as Rs. 5459. There is a difference of Rs.1335.

Now we realize this is nothing but a fraud and we are going through teremendous mental harassment in following up with all the stake holders.

Regards,
Vikas Kulkarni.

I was admitted at MGM Hospital, Vashi, Navi Mumbai for the surgery for the acute appendicitis on acute pain at right abdomen. Reliance general insurance (their TPA) rejected my request for cashless treatment on the basis of that the appendix is not seen in the sonography. Doctors are still arguing that it is not necessary appendix should always see on sonography but clinically and on blood report it can be identified. However I have done this surgery and again approached them through the hospital but again they have rejected it. After all these issues, in the last july the time has come for the renewal and they have collected my cheque for the same and later informed that they will not renew my policy and giving no reason. It was a family policy for my entire family and due to the cancellation they also denied the benefit on a continuous policy. I have submitted all the reports & histopathology report after the surgery and their under writer at govandi office Mr.Sandip kumar agreed and made the remark that it can be renewed but still their higher authorities not ready. My cheque and all papers are still lying with them.

Hi,

I have a health policy from Reliance General Insurance (282550100294). I got hospitalized in the month of September and I was told by their TPA E-Meditek that they don’t have the data of my policy so can provide me a cashless facility. I spoke to reliance and they told me that they are informing the TPA about my policy so that they could update their records.
I cleared my payments and provided all documents to TPA for reimbursement. More than two months have been passed and the status is sae. TPA says they don’t have data of my policy and whenever I call up Reliance they say that they have forwarded my policy details to TPA.
It’s frustrating to deal with these people. Can someone help or is someone form reliance listening.