[Resolved]  Mediclaim — Regarding Denial of mediclaim (cashless facility) from Bharti Axa General Insurance

Address:

Mumbai City, Maharashtra

I purchased on line smart health Insurance policy (Rs.500000 coverage) no. J0002708 from Bharti Axa General Insurance Co. Bangalore, for my son Vishwanath Kamble. Policy start date 03.12.2013 and valid up to 02.12.2014.I admitted my son to Hospital(Purohit Clinic, Panvel) for right soulder dislocation problem, to carry out the surgery. We submitted required papers from Doctor to TPA, Emeditek, Gurgaon, Haryana for prior approval to carry out surgery. All clarifications/justifications provided to TPA (Emeditek) & Bharti AXA GI, Bangalore wide emails from hospital. Surgery carried out on 29.07.14 & was in hospitalized up to 31.07.14. TPA & Bharti Axa Co. requested to submit final bill (Rs.78000) from hospital with discharge summary. Everything required documents submitted to both of them on 31.07.14. First of all both parties were refusing of receipt of documents & every time when we call them, there was no satisfactory reply from them. I was continuous on phone with them for 4 to 5 hours to trace out the submitted documents to both parties. After lot of follow up finally they refused the claim & sent a email to Hospital to recover all bill from patient Vishwanath Kamble. It was surprise to me at the final moment they refused my claim. when we put all papers for claim on 27.07.14, they have not told that we will not get the claim. till final moment they asked all papers, bill, health summary, & we given all clarifications. I am very upset due to such type of behavior of this health Insurance Co. & TPA & caused lot of mental upset to arrange Rs. 78000 from others to pay bill of hospital at the last moment.I would like to highlight to other persons/public beware from such type of Co. & TPA, those who are cheating to innocent peoples. when we apply for policy, they will not come out their policy drawback, terms & conditions.But when we pay an amount for policy to them then, they words the policy as per Co.benefit terms & conditions, which are all against to general public who buy the policy. Request to look into this case seriously, so that other innocent poor, middle class people will not be cheated in future.