Amri Hospitals — Complaint against TPA service

Hi Team, To express my dissatisfaction with the service I receivedfrom AMRI, Bhubaneswar, I am writing. On Nov 1, 2020, my sister(UHID:AM[protected] was admittedto the hospital for delivery. We were entitled to claim up to 50k as we had thecorporate insurance plan, and we sent all the necessary documentation to theTPA desk / via mail for the pre-processing of the insurance claim to avoidfurther delay. The TPA team, sadly, could not do their job effectively. Here, Iwill highlight a few of the problems we have faced.Firstly, after the AMRI TPA had sent the information toVipul on 1 Nov. The insurance company had a question. That was unaddresseduntil after I followed up and shared the mail on Tuesday afternoon. I think itshould have been the duty of the TPA representative to follow up on time.Secondly, on the date of discharge, the first set up billsubmitted for approval was the incorrect format that was refused and thebreakdown requested for price. Again, until I forwarded mail received from theinsurance company, TPA refused to answer it. I don't understand why we don'tfollow any sort of detailed best practice format.Finally, the insurance company sent the approval number(40500INR) at around 3 pm for the first time, and the correction was required andsent at 4 pm (45000INR). But the new final approval was ignored by the TPA andthe bill was processed. Because of the pandemic, we are aware that no one elsewas allowed inside the hospital apart from the attendant. Therefore, my motherwas the best person to support my sister, as in this maternity situation. I wastrying to remotely organize (which the TPA team should have done). Around 6 pm, when my senior citizen mother went to the discharge desk to clear the amount ofthe bill and was asked to pay the balance amount where the second acceptedamount was not considered. I called the discharged desk before that and askedif we should close the bill that they said yes, we got the insurance company’sapproval (they did not mention the exact amount). I always thought, as alayman, that they would have considered the latest approved amount. I reviewedthe bill at home. I found that the latest amount had not been considered. Ireached out to the TPA desk. Unfortunately, the lady TPA representative was so unprofessional.Instead of addressing the issue, she argued with me why the bill was closed.There was an inappropriate response.I am requesting to address my concern as soon as possible. Ichecked with the insurance company they said that they would not refund theamount if we claim as the amount has been accepted to the hospital. My concernis here if the hospital cannot send the amount to the insurance company thenwhere the balance amount lies. It's totally immoral and unconstitutional. Butyou should work on it and arrange the refund we are expected to get, please.In addition, to enhance the service, I would like to suggesta few points below: 1. Train the staffs so that the customer can obtainsuccessful service. Inside the department, I could see several teamworkproblems. 2. We should go for paperless service during this covidcase. Whereas, via email, I should get the blood / other test report. Thedepartment doesn't know when to update the mail I d.3. I could not find anywhere digital payment apps (Paytm, Goolgepay etc). In order to reduce the covid risk, we should avoid physical contact. I hope my issue will soon be solved.