Medi Assist India — Denial of Reimbursement of medical expenditure

Address:

Bangalore, Karnataka

1. The certification of cash less hospitalization for the treatment of my son Mr Sanjay K S, Junior software Engineer, Coupons.com company (Employee Code - 11) for the Ankylosing Spondilitis was not approved by the Medi Assist India TPA Pvt Ltd and advised us to send the bills after treatment for reimbursement. 2. The treatment was given to Mr Sanjay K S, on 08.12.2014, in Bangalore Baptist Hospital, Hebbal, Bangalore – 560024 for the Ankylosing Spondilitis. 3.Accordingly, the original hospital main bill with detailed break up, reports and pre-numbered cash paid receipt, have already submitted to M/S Medi assist India, Bangalore on 30.12.2014 and the ORIGINAL bills/details were sent, given as below, i) The duly filled in reimbursement claim form ii) The split up expenditure details Bill No Bill date Particulars Amount (Rs) [protected].12.2014 Lab Charges 970.00 [protected].12.2014 Medicine charges 82411.00 [protected].12.2014 Medicine charges 60.00 Total Rs 83411.00 iii) The outpatient bill related to Lab charges dtd 05.12.2014 of Rs 970.00 iv) The Doctor’s prescription dtd 05.12.2014 v) The cash paid out patient pharmacy cash receipt dtd 08.12.2014 of Rs 82411.00 vi) The Emergency services treatment record and prescription dtd 08.12.2014. vii) The out patients pharmacy cash receipt dtd 08.12.2014 of Rs 60.00. viii) The outpatient bill for the charges of IV Injection/Infusion/KVO (Medicine) dtd 08.12.2014 of Rs 30.00 ix) The request letter for cash less hospitalization for Medical Insurance Policy 3. As regards the required Investigation reports, sought from Mediassist dated 08.01.2015, the data/information /details ie the Medical Report furnished from the company vide dated 13.01.2015. (copy enclosed) 4. And also it was requested for more information/clarification regarding the medical aspects from Dr Jacob Mathews V. DNB MD (Medicine), Consultant Physician and Rheumatologist of Bangalore Baptist Hospital, . Airport Road, Hebbal, Bangalore and Mail - [protected]@yahoo.co.in, Ph:[protected] Extn- 350) 5. The Insurance Company denied the reimbursement of medical expenses. But as per ‘Employee Benefits Manual’ in Coupons.com Policy, this exclusion is waived & all claims related to Pre-Existing Ailment Is payable from Day one of the policy. 6. It is hence requested to look in reg the reimbursement of medical expenses. Dated 25.02.2015 Yours Faithfully sd/- Enclosures: Siddappa K G 1. Reimbursement claim form Parent of Sanjay K S 2. Bills and prescriptions – 8 # 103/B, 6TH Cross, 3rd Main Road 3. Medical Report Ganganagara, Bangalore- 560032 4. Lab Report