Aditya Birla Sun Life — Health Insurance

Address:

MUMBAI

I have Aditya Birla Sunlife health insurance policy Active health Policy no.[protected] as per policy holder Prashant Shah
I was covid + on 21/06/2020 and discharged on 29/06/20 and had total expenditure of Rs.266127/- in this (Rs.261079/- was during hospitalisation expenses), (Rs.4268/- pre hospitalisation expenses) and (Rs.780/- post).
We have submitted this claim online on 08/07/2020 to Mr.Ashutosh (Aditya Birla Health insurance employee) and he has submitted to claim department. From here our troubles starts as we were told within 3-4 weeks claim will be settle as due to lockdown and pandemic no staff was coming to office all are working from home although this documents are submitted on online platform. After 5th week we have started asking for claim progress as we got regular or same answer claim is in process and told us to wait for one more week. After continuous follow up they have asked us to send hard copy of documents to Thane office address in august and we did the same then in last week of august third party verification person came with motive of rejecting claim. They simply blame us for inflated bills and connected with Dr.Sachin Waghmare Emp. id:0012 he told we got same hospital bills with just 90000/- and also told he has source he can verify wrong doing even also able to check my bank records or whatever he wants about me finally we have shown our bank showing debit of Hospital amount of Rs.250000/- then he went. on 25/09/2020 we have received reimburse Amount of Rs.165649/- out of Rs.266127/- so we have ask for settlement details they settle the claim but details we have to ask else they are not sending after our follow up then only details came after five days of our follow up. They are so rigid or have decided to settle with certain amount so they have deducted Rs.100478/- in settlement letter they have mention or deducted below details
1)200 registration
2)14000/- excess stay not justified (our reply we have stayed for 9 days as per guidelines of government how that is not justified)
3)10000/- intensvisit not justified
4)27000/- not justified (No reason given just not justified)
5)2408/- for some injection charges
6)45000/- not justified ( no reason given just not justified)
Total deduction Rs.98608/-
*there is also mismatch of in amount they have LESS PAID Rs.100478/- (Claim Amount Rs.266127 - less settled amount Rs.165649/- and DEDUCTION AS PER HIM 98608/- mismatch of Rs.1870/-
our claim amount Rs266127/-
less:Settle amount Rs.165649/-
less :deduction amount Rs.98608/-
MISMATCH RS.1870/-
THIS SHOWS HOW THEY ARE SETTLING THE CLAIM ...
With this we have send couple of mail regarding to this every time they acknowledge the mail and in next day query resolve no answer no clarification nothing just query resolve.
We hereby request you to help us as covid guidelines and line of treatments have been changed for every month so if you compare June with September things are different and expenses also we have paid hospital bills through our bank account in this scenario we are the one who has highest trouble as Hospital has taken complete amount Aditya Birla health Insurance denied to pay the amount, rigid or non cooperative behaviour and one side settlement. Not wanted to listen or settle balance amount.

Kindly help us to resolve this issue...

With Regards
PRASHANT V SHAH
[protected]
Email:[protected]@hotmail.com