[Resolved]  Oriental Insurance Company — TTK Healthcare not reimbursing the amount (ORIENTAL INSURANCE COMPANY)

Address:

East Delhi, Delhi

My name is RAVINDER KUMAR, working with Keane India, an NTT Data, company for the last 7 Year, I have corporate policy no. TTK CARD NO. BLR-OI-K[protected]A of ORIENTAL INSURANCE COMPANY TTK Healthcare. TTK Healthcare branch is in Bangalore.
Address of the company
Unitech trade center
Keane India
6th floor
Sector -43
Sushant lok phase -1
Gurgaon

Compalaint against Policy No.. BLR-OI-K[protected]D

B/O MINI Policy no. BLR-OI-K[protected]D
BABY OF MINI admitted in hospital St. Stephen Hospital, Tis Hazari, Delhi twice in the month of December 2011.
BABY OF Mini born on 23rd December 2011 and discharge on 26 December 2011, Baby was stayed in Routine Nursery, I talked many times with ER spoc of our company & TTK to pay is cashless but they ignored it always. After many chats I pay all the bills by my own pocket. When I filed the bill for Baby for medical reimbursement, it was rejected always, everyone says Baby was not enrolled so we cannot approve the amount. Some of the executives of TTK said “You can enroll the Baby with yourself” and some of the executives says “you contact to HR ER spoc, HR will enroll the baby” but they unable to enroll the Baby because its in process we were working on it. Finally I contacted to the ER spoc of our company who is authorized for TTk named “Rashi Chawla” on 26th December 2011 , I sent the details of baby to enroll in the corporate policy. Same “Rashi” forwarded the details of baby to the TTK healthcare concern person named “LEENA”. Baby girl again admitted on 28th of December 2011 for Joendis that time baby was not enrolled so I pay the whole amount again.
At least 5-6 times I sent the details of baby to the Hr spokes “Rashi Chawla” and she also forwarded the mail to 5-6 times to the concern person “Leena” of TTK healthcare, But baby girl not enrolled.
Finally I filed the two claims of baby girl for different dates the medical reimbursement with “ORGINAL DOCUMENTS” in the month of January , but both claims were rejected because baby id was not enrolled. Again we sent the information of baby to enroll in the Policy, but nothing happened. Although I had called so many times to the CCE executive # [protected] (Chandana) but nothing happened I waited 3 months to enroll the baby in the policy
After three months in the month of march on 23rd day nearby, Baby of Mini Id (TTK CARD NO. BLR-OI-K[protected]D) was created and enroll in the policy but there was a shortfall saying “Need document”
Again I have re-submitted the Xerox copies again because “Original Document already sent on January.
After that new claim was generated which was BLR-0412-CL-0000067
In that claim no. BLR-0412-CL-0000067 there is shortfall again saying “NEED ORGINIAL DOCUMENT”

I do not simply understand, why they are asking for the original documents (see last attachment), when the same is submitted earlier. The required ORIGINAL DOCUMENT are already been submitted on dated 10th January 2012. POD details for the ORIGINAL DOCUMENT sent are: [protected] or [protected]. The required document could be found out in the records of the claim number BLR-0112-CL-0003862 OR BLR-0112-CL-0003884. Now you can see the New Shortfall which is made on 23/5/2012,In shortfall still they are asking for“ORIGINAL DOCUMENT” . PlZ fine the attached file of every details with screen shot in ms-format

2.
Compalaint against Policy BLR-OI-K[protected]B

FOR MINI CLAIM ID TTK CARD NO. BLR-OI-K[protected]B

Claim settlement no: BLR-0112-CR-0003106
I Filed claim for my spouse name “MINI” who was admitted twice in the month of November and December in St. Stephen Hospital, Tis Hazari, Delhi. Which is of In-Network Hospital. I filed a claim with ORGINAL DOCUMENT for medical reimbursement, they approved only Rs 370, rest of all the charges were rejected because of Pre-Post Maternity and it was showing only for 26/12/11 but dates are different, Claim was not of Prepost Maternity, rather it was for some other trouble during pregnancy. For this, I sent mail also. They have amalgamated all charges to Rs. 9103.00 and named as ‘prepost Maternity’ is incorrect. Charges were of Medicines, Lab, X-ray during Inpatient admission, which was medically necessary and was prescribed by the doctor. Details with the discharge summary has already been provided in original. All the bills are of St. Stephen Hospital.
Also, per Discussion with CCE of TTK Healthcare I again, re-submitted a separate claim for my wife (Mini) on 9th. March, 2012 amounting to Rs. 13,800.00 (approx), but it is not reflecting to the site.
At last I am totally frustrated to filed the claims again & again copy the bills sending them many times and always got response of rejected. I come to you for help Please help me to resolve this matter, when one of my friend told me. Please make the possible. I m really helpful & need your full support. In case any query please contact me feel free. I am still waiting your reply. PlZ fine the attached file of every details with screen shot in ms-format



Thanks

Ravinder kumar
Mobile # [protected]