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Dear Sir/Madam,
I am writing to express my concern and dissatisfaction regarding the rejection of my reimbursement claim Number[protected] for the treatment of my son. I believe the rejection is based on incorrect or misunderstood reasons, and I would appreciate a thorough review of the matter. Below are the points raised in the rejection, along with my clarifications:
Hospital Registration Expired
Claim Rejection Reason: The hospital registration has expired.
My Response: The hospital’s registration was renewed, and the updated registration details were already submitted along with the claim. Kindly refer to the documents submitted for confirmation.
Consultation Fees
Claim Rejection Reason: Consultation fees of ₹400 and ₹300 were charged.
My Response: When a patient revisits the same hospital within the same week, the hospital provides a ₹100 discount on consultation fees. I was charged as per this policy, and the amounts are valid under this arrangement.
Oxygen Charges (Charged on a Daily Basis)
Claim Rejection Reason: Oxygen charges were charged on a daily basis.
My Response: The oxygen charges applied by the hospital are accurate, as oxygen was essential for my son's treatment and recovery. These charges were necessary for his well-being, as oxygen support was required for his breathing.
No Need for Hospital Admission (Based on Medical Report)
Claim Rejection Reason: According to your medical report, hospitalization was not required.
My Response: Prior to admitting my son, I consulted with a network hospital where cashless facilities are available. The doctors there recommended seeing a specialist pediatrician, which led me to seek treatment at a different facility. My son was having difficulty breathing due to cough and fever, and medical advice indicated that hospitalization was necessary for his condition.
Document Not Signed
Claim Rejection Reason: Some documents were not signed.
My Response: The documents submitted were duly signed. The documents that were not signed are the soft copies I received via email. Any concerns regarding missing signatures could have been clarified directly with me before rejecting the claim.
Given the above clarifications, I respectfully request you to review my claim once more and take the necessary action for reimbursement. If there are any additional queries or documentation required, please feel free to contact me directly.
I look forward to your prompt response and resolution of this matter.
Thank you for your attention to this issue.
Best regards,
Sachin
Policy No.GHI[protected]
Claim Reference Number[protected]
Mobile no -[protected]
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