[Resolved]  HDFC Bank ERGO Family Health Policy — hdfc ergo denial for cashless claim due to which my wife passed away

Address:

Jyotiba Phule Nagar, Uttar Pradesh

Dear sir,
This is to inform you that we have a HDFC ERGO FAMILY HEALTH POLICY. Which cover my wife and myself. My policy no is – 50011923 and my cashless card no is – HN[protected] and expiry date is 28-aug-2011. My complaint is regarding denial of cashless service from hdfc ergo without any proper reason.
This is to state that my wife Mrs. Surabhi Saxena, Age 30 years is suffering from Acute Liver Failure due to Viral Hepatitis and is in Hepatic encephalopathy. She is also 28 weeks Pregnant. On 29th of March 2011 I admit her in international hospital limited (Fortis), Noida. which is one of the network hospital of hdfc ergo. I inform to tpa and complete all the formalities. On 30th of march doctor decided to terminate the pregnancy but that time I know through tpa that my claim is denial and reason behind that is hdfc ergo consultant show it is a case of pregnancy and this is not covered in that policy. At that crucial time I arrange the amount to deposite and started the treatment. Doctor save my new born child but due to insufficient funds we can not able to give him proper treatment because my wife is also in crucial position and I already have a cashless denial from hdfc ergo. So I decided to save my wife first. On 30th of march new born child was passed away due to insufficient funds. Then I call to hdfc customer care and send him a fax on hospital letter head in which doctor given him the clarification that
“ This is to state that patient Mrs. Surabhi Saxena, age 30 years is suffering from acute liver failure due to viral hepatitis and is in hepatic encephalopathy. She is also 28 weeks pregnant and the liver disease has no causative relationship with her pregnancy.”
Dated –[protected] Dept Of Gastroenterology
Dr. AJAY BHALLA
MBBS, DNB(MED),DNB(GESTRO)
Sr. Consultant & HOD
Dept. of Gastroenterology
Fortis hospital Noida

But after that on 31st marth 2011 they send us an additional information request form and asked to provide Antenatal Checkup Record. For this reference I provided him the previous Medical checkup card which show the pregnancy record as per TPA and attended Doctor suggested.
But after providing this also on 1st of april 2011 they send the again the same letter of denial and in that letter they show the reason is
“ cashless facility is denied since the presenting aliments cannot be ruled out for the complications or the concomitant aliments, hence the member is adviced to submit the claim for reimbursement as per the merits of the policy”
At that time I am hopeless and try to arrange funds where ever we get till 4th of april my wife condition is more crucial and I did not have so much funds on 4th of april I paid approx. 5 lacs to fortis hospital and shift my wife to INSTITUTE OF LIVER & BILIARY SCIENCE, D-1, VASANT KUNJ, NEW DELHI.
On 5th of april 2011 she passed away at 9:15 pm.
I can’t say is she died due to that disease or due to lack of funds I never accept a health policy for reimbursement. Now when I send mail to hdfc ergo then they reply me same answer and forced me to submit all papers for reimbursement. Sir please I need your help to get the justice and learned them a lesson so anybody else never faced this type of problem.
I have all the documents regarding this matter. But I don’t know how to proceed.

plz suggest me what to do - my mail id is - [protected]@rediffmail.com
and my contact no is - [protected]