| Address: | Bank of india, Jagir,mainpuri-205247 |
Respected Sir/Madam
With due respect I want to inform you that I am ANKESH KUMAR (PF-219047) working
In BANK OF INDIA, AGRA zone.I had met an accident on 28thjuly2021 while
returning from my office around 6pm when suddenly an Antelope came across road
in front of me but luckily my colleagues coming behind me immediately took me to
Rainbow Hospital, Agra with no delay where my further treatment had been done and
even I have to visit hospital till date for regular checkup as guided by doctor.
As I had severe head injury and left clavicle bone fracture I had to be admitted there for
10 days after which I got discharged with prescription of 3 months bedrest.
As soon as I started feeling some good I filed a Medical Claim with Safeway TPA on
6thseptember2021 with claim no:NI[protected] to reimburse my medical treatment
Expenses of RS.171183.00 . I had sent all the original medical documents as well as
pharmacy bills hard Copies to safeway office New Delhi.Furthur after some time
Safeway TPA raised three to Four queries one by one regarding required documents
which they need from my side.In the first query they asked to send original lab results
documents and discharge Summary.I sent them all the required documents raised in
query in soft copy as well as hard copy timely and it had been been received by safeway
on 19thNovember2021.In second query Safeway TPA asked for 1.Self declaration about
the occurrence 2. Doctor clarification whether patient was alcoholic or not at the time of
hospitalisation 3.MLC/FIR Report.
As I had already sent them original MLC during filing my medical claim with Safeway TPA informed their executives regarding this and they replied positively and asked me to send only self declaration and Doctor clarification so I provided them Self declaration about the occurrence and Doctor clarification that patient was having no sign of alcohol consumption at the time of admission in soft copy as well as hard copy timely.Again they raised query to provide self declaration about accident.when I asked them that I had
already sent self declaration in previous query they replied that they want the each and exact details about how accident occurs so again I send them self declaration about how
my accident occurs in details.After sending all the replies I asked them about my claim reimbursement and their executives replied that now no any queries are left and within 15 days my claim will be reimbursed but after few days Safeway TPA again raised a query regarding MLC.So I called them and told them that I had already provided original MLC during filing the claim and even their executive knows that and they confirmed previously that they have MLC and there is no need need to send any copy.After which safeway executives told that query will be automatically removed in few days and your claim will be settled soon.That time I feel so relaxed that finally after all the trouble and replies my claim is going to settle but that was my imagination. Approx 7 days passed and Safeway TPA had not removed the MLC query from their app so I asked them about that and they replied that the MLC which I provide them is not a valid MLC and I have to provide them another MLC in any other format .I asked them that few days ago they said that MLC is valid and there is no need of any then why there’s sudden change in their statement. I told them that the MLC which I provided them is the only MLC I received from the Rainbow Hospital, Agra.They just keep denying the MLC and asked to provide MLC in other format so I asked them to provide me a format in which they want so that I can talk to hospital but they deny to give any format of MLC and keep saying that MLC I provided them is not valid.So I asked them to send me a email stating the MLC I provide to Safeway TPA is not valid but Safeway TPA also denied to send email.After that I talked to Rainbow Hospital, AGRA regarding any other format of MLC but they replied that the MLC provided to me from the Hospital is the only MLC Rainbow Hospital issue to their Patients.After all that I talked to safeway officials Mrs. Amanpreet regarding all these statement I received from hospital about MLC she told me that OK we are accepting your MLC and proceed your claim process forward which again makes me feel relaxed but again it was just a lie because again after few days when I called them to take a follow up regarding my claim status they replied that their senior officials disapproves MLC so they can not approves that MLC as a valid.That times it feels like Safeway officials made their mind to not reimburse my medical claim and they are turning all the things around .So I called the safeway TPA official MRS.Angelina who handles BANK OF INDIA STAFF medical claim and she told me that they talk to Rainbow hospital and Hospital denies about any MLC given to you.So again I went to Rainbow Hospital Agra to confirm that and asked their Medical Records Department about Hospital denial for my MLC but what they replied makes me Shocked.Hospital clearly states that they had got calls from Safeway TPA regarding MLC of ANKESH KUMAR and and they replied them that YES Rainbow Hospital Agra has provided MLC to MR. ANKESH KUMAR.At the spot I called MRS. Angelina(SAFEWAY TPA officials) and told them that I am here in the hospital and if she wants they can call hospital MRD regarding authenticity of my MLC but she denied to talk to Hospital officials .Even I asked her why she lied about hospital denial but she directly told that its matter of their investigating department.That time again I asked her to send me an email stating Safeway TPA will not consider my MLC as valid document but again she denied to mail and cut the call.That was the time I clearly understand that Safeway TPA and their officials keeps pulling things, changing their statements and turning every thing around, continuously keep lying about claim and its status as they are pre decided not to settle my claim.Even after all my efforts and authentic replies Safeway TPA ultimately rejected my claim after 25thDecember2021 without stating any reason.On asking to send a mail stating reason of rejection they again denied as they denied previously many times. As I was and am on regular follow up with doctor its so hard for me to travel approx 120km from my branch to Rainbow Hospital Agra repeatedly. I went more than four times to Rainbow Hospital for Illogical queries of Safeway TPA regarding MLC.During my medical treatment I lend money from my friend and also I had on bed rest which results in approx 2 months lop is makes me financially unstable.
As being a staff of bank, medical insurance with Safeway TPA is meant to facilitate staff and provide them smooth and easily access to insurance service but what I had to encounter is lots of trouble and feels like I am fighting for my own rights.its really much disappointing and sad to me and what I got is nill reimbursement with much Mentally and Financially harassment.
Kindly help me in getting my medical reimbursement.
Yours sincerely
Ankesh kumar
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