Reimbursement of my medical bill against Mediclam Min No. 15100722 of MDIndia Healthcare Services (TPA) Pvt. Ltd.
I beg to draw to your kind attention that, I have been refused the above sanction by MDIndia Healthcare Services (TPA) Pvt. Ltd. on the pretext of clause (4.10) . The fact is that I have been operated in brain in early 2008, referred by Dr. Prasenjit Chakraborty MD(MED) DM(NEURO) of Ruby General Hospital, Kasba Golpark Kolkata - 700107 to Dr. Mazhar Husain (Head of dept. Neurosurgery) at Lucknow and operation was done in Mayo Hospital Lucknow. After that I was under treatment of Dr. Prasenjit Chakraborty for more than three & half years and now I am about 80% cured.
Last time in July & August 2011, I went to Dr. Prasenjit Chakraborty for routine checking and asked him how long these medicine prescribed by him will continue. He then advised me for C T Head Angio from Apollo Gleneagles Hospital, 58 Canal Circular Road, E.M Bypass , Kolkata- 700054 , and after having the report he will ascertain next course of medicine. Accordingly I got admitted in Apollo Gleneagles hospital on 07.09.11 empanelled by MD India Healthcare Services (TPA) Pvt. Ltd. for cashless treatment . Had Ruby General Hospital was equipped with such facilities, the same could have done there which is also authorized by MD India Healthcare Services (TPA) Pvt. Ltd. What is in reality the same C T Head Angio was done in Apollo Gleneagles Hospital for the same cause. So the question of clause (4.10) are not applicable hear in my case as this is a post operation treatment. However, there is no mention of clause (4.10) anywhere in the booklet given by them. Further my case is a long term for nearly 4 years and a continuous treatment, do the same should not be simply treated as test report. As per table of benefit 8.1.1 of page no. 6, I was admitted for more than 24 hours and released.
Mediclaim policy (cashless) is for the mediclaim member in true sense. There is no falsification or untrue in my case. If needed the clause (4.10) required to be amended to facilitate the patient of their benefit for which MDIndia Healthcare Services (TPA) Pvt. Ltd. is meant for, please note. However, I request your good office to go through the above thoroughly and arrange to refund me an amount of Rs. 16,816.87 ( Rupees sixteen thousand eight hundred sixteen & eighty seven paisa only ) that I had to pay Apollo Gleneagles Hospital for getting myself released on 08.09.11 in the evening. As in a democracy nobody should be deprived of their genuine claim and proper justice is a must.
Moreover, MDIndia Healthcare Services (TPA) Pvt. Ltd., Kolkata office at 169 Sarat Bose Road Kolkata - 700026 ( e_mail: firstname.lastname@example.org ) deliberately trying to delay the proceedings by not sending original bill details along with refusal letter inspite of repeated reminder to them.
Min No. 15100722
Address of Head Office:
MDIndia Healthcare Services (TPA) Pvt. Ltd.
300/E B B Road S no-46/1 E – Space, A 2- Wing, 3rd Floor
Haridevpur P O Pune Nagar Road, Vadgaonsheri
Kolkata – 700082 Pune- 411014
( 9051299069 ) ( Ph: 020-2530-0000 Fax: 020-2530-0003 )