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Heritage Health TPA Pvt. Ltd. c/o National Insurance Co. Ltd - Non payment of official claim of mediclaim

 
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  Mr. Changrani Arjan Atmaram
Please select Insurance co followed by the Policy Number and Issuing office code to register Card related grievance


Please select Insurance co followed by the Policy Number and Issuing office code and Card Number to register Claim related grievance




Nature of Grievance

CardClaim


Select Insurance Company

--Select-.National Insurance Co. Ltd.New


Policy Number 250500/48/09/8500007102 VALID 15/11/2010




Card Number HHS1. 0200695908




Claim Number HH 121004708




Issuing Office Code 250500




Complaint Non payment of genuine Claim.

Wednesday, March 10, 2010
10:07:31 AM

The Director,
Heritage Health TPA Pvt. Ltd.,
Asian House D - 7, 1st Floor,
Road No. 16, M.I.D.C.
ANDHERI (EAST), MUMBAI 400093

Attn.Ms.K. SHAMA CHAUHAN

Dear Madam,

CLAIM NO. HH121004708

Please collect the file which is with Mr. Dinesh at the counter and after reading please do the needful. Please go through my covering letter with the claim which is very clear and explain every point of my claim.

I have sent the E – Mail to Dr Gupta which he must have seen by now.

I was in your office at 12.15 noon on 9th March, 2010 and with the help of Mr. Dinesh I was able to get the list of items which u have disallowed.

I am insured with National since 1985 and if u see I do not claim anything which is wrong.

Please refer my covering letter which is self explanatory.

Before approving my claimless I was called by the BSES hospital to give them the old history as Heritage want to know how I came to know that I have bad knee and that is to operated. So you were thinking that I am connived with hospital and doctors to claim the same. I was having pain and I got checked in Mahavir Hospital where Dr. Allhabadia told me that I Have bad knee and if not treated now then I may suffer in other leg.

I could not believe and went to Dr. Ashit Shah in Asian Hospital on 18.4.2009 and he asked me for the tests and after seeing my X ray he also told me the same. I paid Rs.1100=00 item no 10 on your rejection list.

I again went to Hiranandani Hospital as to operate in Asian was Expensive and consulted DR. Kiran who also asked for tests and to go to physio to know exercises till I decide for operation. Rs.1200=00 items 1.2.3. And 4 on your list.
If you see all the bills Dr. Ashit Shah has not charged me any thing for consultations on 9th and 10th Dec. 2009 as I told him that I may not be able to afford the same and as I Have to claim my last consultation please consider the same.

Item. 5 Rs3830=00 if I have not gone for the tests how they shall know that what I am suffering from before any major operation and how shall the BSES should have replied u that how I came to know about knee problem.

Item No. 8 Rs. 6,000=00 paid to Physio Therapist as suggested by Doctor and it is must after the operation and I do not know your language that Dr. Limit Exhausted.

So please do not deduct anything from my above bills as I have not submitted the bills from aayarvedic hospital and also from Hamdard Hospital in Delhi as I thought I am not entitled for that.

Please go through all and discuss with your head of department Ms. Cauhan and decide.

The reputation of TPA is already bad as been advised by Hospital and Doctors when I questioned then on exorbitant charges they told me that they are paid after three to four months.

My deposit is also stuck with BSES as they are not releasing because of your delayed payment.

Please do not force me to proceed to Consumer court as I have not claimed any unjustified expenses.

You mean to say without physio therapist ( Please read the instruction of Dr. Ashit Shah on discharge note the treatment was for 30 days) I would have been able to walk if yes then I would move to court against you and your company for mental tension given to me as senior citizen and after approval to wait for my money for three months. If I would have got operated in Asian and or Breach Candy I would have been paying interest on loan from bank.

Your immediate action shall be highly appreciated.
Thanking you, I remain,

Yours truly,



Arjan Changrani.
Phone No. 9920380129




Name of Insured




Address

Plot 205, Flat 404, Khar Rose MInar,
10th Road, Khar (West),
Mumbai 400052


Phone Number




Mobile:




Email Address










Wednesday, March 10, 2010

10:07:31 AM



The Director,

Heritage Health TPA Pvt. Ltd.,

Asian House D - 7, 1st Floor,

Road No. 16, M.I.D.C.

ANDHERI (EAST), MUMBAI 400093



Attn.Ms.K. SHAMA CHAUHAN



Dear Madam,



CLAIM NO. HH121004708



Please collect the file which is with Mr. Dinesh at the counter and after reading please do the needful. Please go through my covering letter with the claim which is very clear and explain every point of my claim.



I have sent the E – Mail to Dr Gupta which he must have seen by now.



I was in your office at 12.15 noon on 9th March, 2010 and with the help of Mr. Dinesh I was able to get the list of items which u have disallowed.



I am insured with National since 1985 and if u see I do not claim anything which is wrong.



Please refer my covering letter which is self explanatory.



Before approving my claimless I was called by the BSES hospital to give them the old history as Heritage want to know how I came to know that I have bad knee and that is to operated. So you were thinking that I am connived with hospital and doctors to claim the same. I was having pain and I got checked in Mahavir Hospital where Dr. Allhabadia told me that I Have bad knee and if not treated now then I may suffer in other leg.



I could not believe and went to Dr. Ashit Shah in Asian Hospital on 18.4.2009 and he asked me for the tests and after seeing my X ray he also told me the same. I paid Rs.1100=00 item no 10 on your rejection list.



I again went to Hiranandani Hospital as to operate in Asian was Expensive and consulted DR. Kiran who also asked for tests and to go to physio to know exercises till I decide for operation. Rs.1200=00 items 1.2.3. And 4 on your list.

If you see all the bills Dr. Ashit Shah has not charged me any thing for consultations on 9th and 10th Dec. 2009 as I told him that I may not be able to afford the same and as I Have to claim my last consultation please consider the same.



Item. 5 Rs3830=00 if I have not gone for the tests how they shall know that what I am suffering from before any major operation and how shall the BSES should have replied u that how I came to know about knee problem.



Item No. 8 Rs. 6,000=00 paid to Physio Therapist as suggested by Doctor and it is must after the operation and I do not know your language that Dr. Limit Exhausted.



So please do not deduct anything from my above bills as I have not submitted the bills from aayarvedic hospital and also from Hamdard Hospital in Delhi as I thought I am not entitled for that.



Please go through all and discuss with your head of department Ms. Cauhan and decide.



The reputation of TPA is already bad as been advised by Hospital and Doctors when I questioned then on exorbitant charges they told me that they are paid after three to four months.



My deposit is also stuck with BSES as they are not releasing because of your delayed payment.



Please do not force me to proceed to Consumer court as I have not claimed any unjustified expenses.



You mean to say without physio therapist ( Please read the instruction of Dr. Ashit Shah on discharge note the treatment was for 30 days) I would have been able to walk if yes then I would move to court against you and your company for mental tension given to me as senior citizen and after approval to wait for my money for three months. If I would have got operated in Asian and or Breach Candy I would have been paying interest on loan from bank.



Your immediate action shall be highly appreciated.

Thanking you, I remain,



Yours truly,







Arjan Changrani.

Phone No. 9920380129




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Complaint comments 2 Comments     Updated:
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Comments

 
I need the proper justice against insurance and TPA as they have harrssed me since dec. and evedn before filling and going for operatio. I am sr, Citizen aged 71 and they should know that we do not steel money to pay.
N May 26, 2011 by
User
sureshkumar mididoddi  
 
i would like to know my calim details (how much amount have been charged) by the National Insurance Co.(Heritage Health TPA PVT LTD) on 24-4-2011 in Pramoda Hospital, Warangal. Card No.HHS10444727116. P.No.551303/46/10/8500000003

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    Heritage Health TPA Pvt. Ltd. c/o National Insurance Co. Ltd - Non payment of official claim of mediclaim