[Resolved]  Religare Health Insurance — Cashless Policy a Big Fraud. I need Explanations.

Address:

Mumbai City, Maharashtra

Religare’s Cashless Policy is a total farce. Please avoid.

Insurer Name: Shabbir Hussain Kagzi
Policy Number: 10061372
TPA: Mediprobe Consultancy Private Limited
Claim Number: 80022850
Religare Reference Number: [protected]

Shabbir (my father) had visited Dr. Eric Borges at Bombay Hospital in Mumbai on 26 June 2014. He had been suffering recurring chest pains since 12 June 2014. Upon examinations the doctor advised angiography to be conducted. For the same, he was admitted to Bombay Hospital on 27 June 2014. Upon angiography, the doctors found out that he harboured 99% blockages in a main artery and an emergency heart bypass surgery was conducted by Dr. Aniruddh Trivedi on 30 June 2014. Thankfully, the surgery was successful and he was discharged on 11 July 2014.

He had applied for Religare Health Insurance in December 2013 and the policy start date is 25 December 2013. That time the Religare agent was behind our life to make the premium payment and promised tall (and subsequently I realize, farce) benefits of cashless admissions in some 100s of hospitals across India, additional benefits, blah, blah, blah. We finally gave in, premium paid, policy made and a fancy Insurance card was given. We were told that we just have to flash that Insurance card at any partner hospital for cashless admissions. Religare said that now we can transfer our health worries to them. And as stupid and naïve we were we believed.

Come 27 June 2014. I requested for cashless admission of my father by showing his Insurance card. The hospital thought I was dumb [censored] to believe that such thing ever exists. They gave a form with multiple pages to be filled and several documents to be attached. I ran from pillar to post to get the things in place. I was told that a reply will be received within 4 hours. Subsequently, Religare requested for more papers and more details. This continued. Meanwhile, my father kept fighting for his life. Doctors told that the operation had to be performed immediately and we had to arrange Rs. 3.5 lakhs on a Sunday (29 June 2014). That experience was nothing short of hell. Meanwhile, our file was laying somewhere in Religare’s systems who had very conveniently asked us to surrender our health problems to them. We believed and we suffered. Finally, we managed payments with help of relatives and friends. Operation was conducted successfully next Monday (30 June 2014) and my father was in ICU until 7 July 2014. Till this time I had already been forced to deposit Rs. 6.9 lakhs to the hospital.

Meanwhile, Religare did wake up from their slumber and passed on my query to their TPA Mediprobe Consultancy Private Limited and the claim manager assigned was Ujwala Chavan. As insensitive and as heartless these people could be, they sent their agent right into the ICU room of my father where he was lying unconscious to “enquire about the claim” and gather information. This was when the doctors had given us strict instructions to not meet the patient and we used to sit outside the ICU room for hours together to be able to get one glimpse of my father. Upon raising this with Ms. Ujwala, she had the audacity to tell that she had sent an agent to just give best wishes to the patient. Really!? Is that what you people do? Are you so heartless? Then I requested her to reach me directly for any queries. TPA agencies don’t understand that more than the patient, it is the relatives who suffer and go through mental agony. Mediprobe then kept calling me asking for almost the same documents that I had already submitted. And they kept calling me 10 times a day to submit the required documents. Sure, Mediprobe you are running a business. But please don’t be so insensitive, brutal and ruthless that you don’t understand that the patient’s kin have many other duties to fulfil at priority rather than replying to your queries immediately. This was not it. They called directly to the nurses section on the floor where my father’s ward was and started enquiring from whoever was available at that point of time in my father’s room. Seriously, is this the way you work. Religare, these are your tall claims of “Ab Health Hamesha” and “Values that Bind”. Please get a reality check done on yourselves.

Finally I re-submitted the required documents and additional document from the surgeon. Please remember this processing was all happening for CASHLESS ADMISSION, 10 days after admission and when I had already paid Rs. 6.9 lakh. I could just cry at my desperate situation or just laugh at my stupidity of trusting Religare with the most important decision of my life.

Meanwhile, thanks to God my father was recovering well. Finally, on 9 July 2014, I get a courtesy call from one Mr. Debashish Das of Religare, telling me in a very indifferent note “Sir your claim for cashless has been rejected. Please contact your nearest branch if you want to reclaim your amount.” With utter shock, I asked the reason. The reason he mentioned was that “they had a doubt that my father suffered an illness before the insurance policy was made”. Seriously! How lousy and shameless a reason that could. What a way to play with someone’s emotions. You are telling me this on what ground, I asked? Mr. Das said, “we have a doubt”. That is it? You have a doubt. I said you conducted blood tests and stress tests which were completely cleared during the time of the policy. How is it that you didn’t have any doubts that time? On further insisting, he just declined to give any comments and just said that if I have any further queries I can email to [protected]@religare[dot]com. Is that it? On real pleading, he agreed to send me an email with the reason for denial. Apart from their DOUBT, another reason they cited is that we failed to give documents of previous history of illness inspite of multiple reminders. What a shame! What a mockery of the patient. You are hell bent on proving that he was ill since months. Where do I get documents from if nothing exists? I gave them a document from the surgeon suggesting that there was no previous history. But to this, Religare said they can’t consider that letter.
With teary eyes when I told this to the surgeon, he just told me one thing – “If your dad had been harbouring this serious illness since past 6 months he wouldn’t have been able to make it till now. Go and tell this to the Insurance company.” I was speechless after that.
Helpless, I wrote to Religare and as expected there has been no response since then. Eventually, I cleared the entire bill and got my father back home on 11 July 2014.

After this, few things are clear:
1) Religare are denying my claim on false doubts that my father harboured an illness before the insurance policy was made.
2) If Religare think that my father had an illness from before, why did their blood tests and stress tests were completely clear?
a. That means, Religare’s claim of point 1) above is false
b. Religare did get to know that there was something wrong with my father’s health and they still decided to go ahead with the policy, keeping us in dark. This is unlawful in any case
3) Even if I were to believe for a second that my father had a previous illness, that can’t be the ground to deny the claim. What are health insurance companies for. Does that mean they will help only healthy individuals who fall ill for the first time?

This incident has proved that all the tall claims by Religare for cashless admission, benefits etc are 100% total farce. Companies like these act as your best pals when they want to squeeze money out of your pockets to reach their targets. When customers require their help they are far from being helpful.

This incident has amounted not only to financial loss but also to extreme mental torture and waste of time. I assure that I will take required legal action and not give to these dastardly tactics of the Insurance Company.

Religare, I am still waiting for a response from you.

Thanks.
Ali Asgar Kagzi