Aditya Birla Health Insurance — Claim Reject

Aditya Birla Health Insurance — Claim Reject - Wrong Reason

C Chetanzope Sep 4, 2021 Sep 4, 2021 This thread was updated on Sep 4, 2021

Dear Gaurav Tripathi, Policy Number: [protected] Policy Holder: Chetan Zope Cliam Number: [protected] Patient Name: Mrs Nilima Vilas Team please contact your panel doctor which is investigate the patient at the time of policy opening, we clearly mention no any earlier diseases to the patient. I wish to inform you that the i had taken up activ assure - diamond policy for sum of Rs.300000 in the year[protected]. While taking the policy as a mandatory requirement as insisted by aditya birla, i have under gone all medical tests on concall due to Covide-19 as per aditya birla told us as per requirement of aditya birla before policy issue with your recognized panel of doctors during their check-up all the parameters were fine. When i had a admited in hospital for my further course of treatment i had undergone further course treatment at Shree Datta hospital (Jalgaon Maharashtra India) I had given my request for reimbursement claim as per treatment as per the provision available in the policy. However, from long time from April-2021 to Sep-2021 i am shocked to receive your message as follows. ""On scrutiny of the documents it has been observed that On scrutiny of the documents it has been observed that the patient was admitted for treatment of Covid 19. However, the patient has a history of Hypertension since 2 years, which was not disclosed in the proposal form. and hence we are unable to approve the claim."" Since rejection of my claim is base-less i had again resubmitted all original bills along with documents through insurance form part a & b as per insurance provision. My reference number for the claim as per above mention the same has also been rejected due to the following reason On scrutiny of the documents it has been observed that the patient was admitted for treatment of Covid 19. However, the patient has a history of Hypertension since 2 years, which was not disclosed in the proposal form. Since i am not accepting the reason for rejection, i had taken up with the grievance cell about my rejection. Since the grievance cell has also rejected my claim without any valid remarks, i further escalating the same as per the provision of insurance Was this information helpful? No (0) Yes (2)
Sep 04, 2021 Updated by Chetanzope Dear Gaurav Tripathi, Policy Number: [protected] Policy Holder: Chetan Zope Cliam Number: [protected] Patient Name: Mrs Nilima Vilas Team please contact your panel doctor which is investigating the patient at the time of policy opening, we clearly mention no earlier diseases to the patient. I wish to inform you that the i had taken up activ assure - diamond policy for sum of Rs.300000 in the year[protected] &[protected]. While taking the policy as a mandatory requirement as insisted by aditya birla, i have under gone all medical tests on concall due to Covide-19 as per aditya birla told us as per requirement of aditya birla before policy issue with your recognized panel of doctors during their check-up all the parameters were fine. When i had a admitted in hospital for my further course of treatment i had undergone further course treatment at Shree Datta hospital (Jalgaon Maharashtra India) I had given my request for reimbursement claim as per treatment as per the provision available in the policy. However, from April-2021 to Sep-2021 i am shocked to receive your message as follows. ""On scrutiny of the documents it has been observed that On scrutiny of the documents it has been observed that the patient was admitted for treatment of Covid 19. However, the patient has a history of Hypertension since 2 years, which was not disclosed in the proposal form. and hence we are unable to approve the claim."" Since rejection of my claim is base-less i had again resubmitted all original bills along with documents through insurance form part a & b as per insurance provision. My reference number for the claim as per above mention the same has also been rejected due to the following reason On scrutiny of the documents it has been observed that the patient was admitted for treatment of Covid 19. However, the patient has a history of Hypertension since 2 years, which was not disclosed in the proposal form. - Not Accepted please call aditya birla doctor which is health check up of patient at the time policy opening. Since i am not accepting the reason for rejection, i had taken up with the grievance cell about my rejection. Since the grievance cell has also rejected my claim without any valid remarks, i further escalating the same as per the provision of insurance. Thanks & Regards, Chetan Zope
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