Apollo Munich Health Insurance Company Limited — Not passing my claim

Address:

Hoshiarpur, Punjab

Company is not settling my reimbursement claim, i had mail and handover all the necessary document to the company, even though they are not approving my claim My Policy no 170100/11001/AA00050352, My Name : Kiran Vishwanath Tilekar My Name is Kiran Vishwanath Tilekar, having your health Insurance policy, policy no 170100/11001/AA00050352, I was admitted in Jahangir Hospital on 31.08.2014 because of Dengu fever and I done my treatment there and paid the bill. First I had applied for cashless claim but it was rejected due to non disclose of facts and for the same I had send an e-mail from hospital to apollo but my cashless claim was not approved and I received Email from Mukesh Pandey, customer relationship Management Team, cashless facility cannot be granted due to non dis closer of facts and you can go for reimbursement. The nondisclosure fact which has been observed is hypertension from 6 months which was actually from 3 month before. But in Hospital Documentation they had recorded wrongly that my hypertension is from 6 months & for the same I had submitted letter from Jahangir Hospital’s Doctor who recorded wrongly in hospital documentation and also submitted the doctor’s prescription and first consultation letter from doctor for hypertension. So please consider the fact and it is the fault of hospital record and not my so please consider the fact and approve my claim. And then I applied for reimbursement claim and submitted the all hospital documents & my hypertension consultation papers in that reimbursement claim. And after that i received the letter from Appolo saying that Submission of Documents for Claim Id 217556/1, UHID : [protected], the documents which I have to submit are Cancelled cheque copy (Huvepharma Sea Pune) & All previous case papers of Hypertension. After that I submitted Cancelled cheque copy, Previous consultation report in Apollo Munich Pune office, but pune office, didn't forward my document to main office and on 13.10.2014 i received letter from apollo saying your documents not received hence we regret to inform you that your claim has been closed. (Letter is actually received by post on 28.10.2014) Before receiving this letter, i had called your call center of Apollo they said documents required is still pending then i visited pune office for inquiry about why my documents not submitted to your main office, then pune office executive said that your documents has already been submitted. I submitted all the documents needed but pune office not forwarded to main office and apollo had sent me claim closure letter. after that i email all the document to apollo and apollo is saying that submit the first consultation prescription then i submitted the first consultation prisciription then alos they are saying submit the first consultation proscription. I want my claim amount from apollo that's it. I Am attaching the email convesession with apollo munich On 14 January 2015 at 13:24, customer service <[protected]@apollomunichinsurance.com> wrote: Dear Mr. Tilekar, Greetings from Apollo Munich. With reference to your concern, please note that we have reviewed the case again but the submitted documents cannot be consider. Kindly arrange for the 1st consultation prescription for further process. For any further query, you can get in touch with us on our toll-free[protected] or write to us [protected]@apollomunichinsurance.com. You may also contact our nearest branch (for complete list of branches visit www.apollomunichinsurance.com). We look forward to providing you uncomplicated health insurance services. Regards, Ankita Prasad, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website - http://www.apollomunichinsurance.com “Apollo Munich offers its customers free consultation for common ailments. To talk to our experts and for free consultation, you can dial [protected] between 9 AM to 6 PM, Monday to Friday”. From: customer service Sent: Monday, January 12, 2015 4:37 PM To: 'kiran tilekar' Cc: [protected]@apollomunichinsurance.com; Nilesh Tilekar Subject: RE: Regarding Claim Reimbursement (Claim ID : 217556/1) or complaint no. 1271740 Dear Mr. Tilekar, Please accept our sincere apology for the delay in response. With reference to your mail below, would like to inform that the issue has been forwarded to the team concerned for necessary action and the same is currently under process. We will surely get back to you and request you to kindly co-operate with us. For further assistance, please feel free to write us. We look forward to providing you uncomplicated health insurance services. Regards, Ankita Prasad, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website - http://www.apollomunichinsurance.com From: kiran tilekar [mailto:[protected]@gmail.com] Sent: Friday, January 09, 2015 6:29 PM To: customer service Cc: [protected]@apollomunichinsurance.com; Nilesh Tilekar Subject: Re: Regarding Claim Reimbursement (Claim ID : 217556/1) or complaint no. 1164605 Dear All It has been 10 days, I haven't received any reply regarding my claim status. On 30 December 2014 at 10:38, customer service <[protected]@apollomunichinsurance.com> wrote: Dear Mr. Tilekar, Greetings from Apollo Munich. With reference to your case Id: 1271740, please note that the claim request and the documents are being reviewed by the respective team and the updated status regarding the same can be confirmed within 6-7 working days. For any further query, you can get in touch with us on our toll-free[protected] or write to us [protected]@apollomunichinsurance.com. You may also contact our nearest branch (for complete list of branches visit www.apollomunichinsurance.com). We look forward to providing you uncomplicated health insurance services. Regards, Ankita Prasad, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website - http://www.apollomunichinsurance.com “Apollo Munich offers its customers free consultation for common ailments. To talk to our experts and for free consultation, you can dial [protected] between 9 AM to 6 PM, Monday to Friday”. From: customer service Sent: Tuesday, December 16, 2014 1:29 PM To: 'kiran tilekar' Cc: '[protected]@apollomunichinsurance.com'; 'Nilesh Tilekar' Subject: RE: Regarding Claim Reimbursement (Claim ID : 217556/1) or complaint no. 1164605 Dear Mr. Tilekar, Thank you for contacting Apollo Munich. The case number for your below mentioned concern raised on 14/Dec/2014 is 1271740. We assure you an appropriate response within a maximum of two weeks’ time If you do not hear from us within two weeks of this e-mail or not happy with the resolution, you may write [protected]@apollomunichinsurance.com . Please refer to the policy wording and / or visit our website www.apollomunichinsurance.com to know the “Grievance Redressal Procedure”. Do remember to quote the case number mentioned above for ease of identification. We look forward to providing you uncomplicated health insurance services. Regards, Ankita Prasad, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website - http://www.apollomunichinsurance.com “Apollo Munich offers its customers free consultation for common ailments. To talk to our experts and for free consultation, you can dial [protected] between 9 AM to 6 PM, Monday to Friday”. From: kiran tilekar [mailto:[protected]@gmail.com] Sent: Sunday, December 14, 2014 7:50 PM To: customer service Cc: [protected]@apollomunichinsurance.com; Nilesh Tilekar Subject: Re: Regarding Claim Reimbursement (Claim ID : 217556/1) or complaint no. 1164605 Dear Sir, I am submitting The first consultation prescription paper that you wanted. please pass my claim as early as possible. Regards Kiran Tilekar [protected] On 10 December 2014 at 12:39, customer service <[protected]@apollomunichinsurance.com> wrote: Dear Mr. Kiran Tilekar, Greetings from Apollo Munich. With reference to your case Id: 1164605, would like to inform that case cannot be re-opened based on the documents submitted to us. Kindly provide First Consultation Prescription Paper in order to get the case processed. If you are not happy with the resolution, you may write to [protected]@apollomunichinsurance.com . Please refer the policy wording and / or visit our website www.apollomunichinsurance.com to know the “Grievance Redressal Procedure”. For any further query, you can get in touch with us on our toll-free[protected] or write to us [protected]@apollomunichinsurance.com. You may also contact our nearest branch (for complete list of branches visit www.apollomunichinsurance.com). We look forward to providing you uncomplicated health insurance services. Regards, Ankita Prasad, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website - http://www.apollomunichinsurance.com “Apollo Munich offers its customers free consultation for common ailments. To talk to our experts and for free consultation, you can dial [protected] between 9 AM to 6 PM, Monday to Friday”. From: kiran tilekar [mailto:[protected]@gmail.com] Sent: Monday, December 08, 2014 6:19 PM To: customer service; [protected]@apollomunichinsurance.com Cc: Nilesh Tilekar Subject: Re: Regarding Claim Reimbursement (Claim ID : 217556/1) or complaint no. 1164605 Dear Sir, It has been ten days, we didn't receive any reply from you. On 28 November 2014 at 16:46, customer service <[protected]@apollomunichinsurance.com> wrote: Dear Mr. Kiran Tilekar, At the outset please accept our sincere apology for the inconvenience cause to you. We would like to update you that we have already raised your complaint 1164605 to the concerned team for necessary action and the same is currently under process. We will surely get back to you and request you to kindly co-operate with us. In case you need any further assistance, Please feel free to write back to us. We look forward to providing you uncomplicated health insurance services. Regards, Mukesh Pandey, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website -www.apollomunichinsurance.com From: kiran tilekar [mailto:[protected]@gmail.com] Sent: Thursday, November 27, 2014 6:52 PM To: customer service; [protected]@apollomunichinsurance.com Cc: Nilesh Tilekar Subject: Re: Regarding Claim Reimbursement (Claim ID : 217556/1) Dear Sir What type of first consultation paper you need that i don't know, i already had submitted the first prescription which doctor gives me at first time and also the declaration from doctor about the consultation on hypertension. When i had gone to doctor to consult first time on hypertension he only gives me the prescription of medicine and give advice nothing else he give. so please treat this declaration report as a consultation and pass my claim as early as possible other wise i have to go to consumer court and lounge a complaint against apollomunic. and please clear me that what is connection between the hyper tension and dengue?????. i dont know why you are not passing my claim ?????? On 24 November 2014 at 11:37, customer service <[protected]@apollomunichinsurance.com> wrote: Dear Mr. Kiran Tilekar, Greetings from Apollo Munich. With reference to your case id 1164605, please be informed that claim cannot be re-opened based on the documents submitted. Kindly provide First Consultation Prescription Paper inorder to get the case processed further. For any further query, you can get in touch with us on our toll-free[protected] or write to us [protected]@apollomunichinsurance.com. You may also contact our nearest branch (for complete list of branches visit www.apollomunichinsurance.com). We look forward to providing you uncomplicated health insurance services. Regards, Mukesh Pandey, Customer Relationship Management Team Apollo Munich Health Insurance Company Limited iLABS Centre, 2nd & 3rd Floor, Plot No 404 - 405, Udyog Vihar, Phase – III, Gurgaon -122016, HARYANA Website -www.apollomunichinsurance.com From: kiran tilekar [mailto:[protected]@gmail.com] Sent: Friday, November 21, 2014 3:46 PM To: [protected]@apollomunichinsurance.com; customer service Cc: Nilesh Tilekar Subject: Fwd: Regarding Claim Reimbursement (Claim ID : 217556/1) Dear sir/madam I had sent a mail on 31.10.2014 regarding the following issue of reimbursement but after 21 days i got a called from apollo call center, and executive who called said that in your mail, there are no attachments in your mail, so i am forwarding the same mail which i sent earlier now i had to really say that look for attachment. [protected] Forwarded message ------- From: kiran tilekar <[protected]@gmail.com> Date: 31 October 2014 19:46 Subject: Regarding Claim Reimbursement (Claim ID : 217556/1) To: [protected]@apollomunichinsurance.com, [protected]@apollomunichinsurance.com My Name is Kiran Vishwanath Tilekar, having your health Insurance policy, policy no 170100/11001/AA00050352, I was admitted in Jahangir Hospital on 31.08.2014 because of Dengu fever and I done my treatment there and paid the bill. First I had applied for cashless claim but it was rejected due to non discloser of facts and for the same I had send an e-mail from hospital to you but my cashless claim was not approved and I received Email from Mukesh Pandey, customer relationship Management Team, cashless facility cannot be granted due to non discloser of facts and you can go for reimbursement. The nondisclosure fact which has been observed is hypertension from 6 months which was actually from 3 month before. But in Hospital Documentation they had recorded wrongly that my hypertension is from 6 months & for the same I had submitted letter from Jahangir Hospital’s Doctor who recorded wrongly in hospital documentation and also submitted the doctor’s prescription and first consultation letter from doctor for hypertension. So please consider the fact and it is the fault of hospital record and not my so please consider the fact and approve my claim. And then I applied for reimbursement claim and submitted the all hospital documents & my hypertension consultation papers in that reimbursement claim. And after that i received the letter from you saying that Submission of Documents for Claim Id 217556/1, UHID : [protected], the documents which I have to submit are Cancelled cheque copy (Huvepharma Sea Pune) & All previous case papers of Hypertension. After that I submitted Cancelled cheque copy, Previous consultation report in Apollo Munich Pune office, (acknowledgement of all document submitted attached), but pune office, didn't forward my document to main office and on 13.10.2014 i received letter from apollo saying your documents not received hence we regret to inform you that your claim has been closed. (Letter is actually received by post on 28.10.2014) Before receiving this letter, i had called your call center they said documents required is still pending then i visited pune office for inquiry about why my documents not submitted to your main office, then pune office executive said that your documents has already been submitted. What we have to do in this case you tell me???????? I submitted all the documents needed but pune office not forwarded to main office and apollo had sent me claim closure letter. If my claim is not passed from you then i will go consumer court and launch a complaint against apollo munich. So please update me about the same. Thanks & Regards Kiran Tilekar