Apollo Munich Health Insurance — Apollo Munich Not settling the ClaimNo-139756 for Policy No-[protected] since from past 3 Months

Address:

Gurgaon, Haryana

Dear Sir, As per requirements of Apollo Munich health Insurance company, I have sent the supporting letter to Apollo Munich team regarding my Treatment for reimbursement.I have taken policy from Apollo Munich on 4th May with Policy No-[protected] on 4th May and claimed the hospitalization reimbursement in the month of Aug-2013 but since from past 3 Months, my claim was not settled by Apollo Munich Health Insurance and after 3 Months, they have closed my case via FHPL team, the CaseID is-139756.They have sent me Query Letter dated 14th Nov-2013 in which all the pending documents were in RECEIVED STATE but as soon as i have shooted an email to Apollo Greviance Team on 19th Nov-2013 morning, they cleverly sent me another 19th Nov-13 Query Letter in which some documents were in PENDING STATE.Every time they are raising unwanted queries again and again, please take a concrete action for the same. Best RegardsZeba Khan Apollo Munich Policy No-[protected] Trailing email for your reference:- On Fri, Dec 6, 2013 at 4:55 PM, Sameer K <[protected]@gmail.com> wrote: Hi Team, FYI, Before starting, I would like to let you know that all the calls recorded voice, proper documents and email communication are with me for future reference to be given to IRDA team. You have always taken more time than your SLA, provided wrong committments on phone and have done conspiracy for processing my Reimbursement case. This[protected] Harassment Link by Apollo Munich would also shows the same, how you are harassing the customers...and the IRDA team would teach you the lesson on this so that other customer won't get hampered because of this in future... http://www.consumerforums.in/harassment-from-apollo-munich-health-insurance-comp...⇄ Ok fine, Pls provide this below question's answers to me, Based on this I would either approach Insurance Ombudsman/IRDA team or would file the case in Delhi Jurisdiction... Do you need 4 Months to understand that Documents were not upto the mark .If All the documents status were already in "RECIEVED" STATE as of 14th Nov-2013 then why you have come back to us, on 2nd Dec-2013 that the case is closed. Provide proper mitigation explanation here. Zeba was been hospitalized on 13/08/13 to 18/08/13 and the Reimbursement documents has been submitted to you on 25/08/2013 but after 3 Months, on 2nd Dec-2013, you have closed my case-139756. May i know the SLA(Service Level Agreement) of processing of the claim?? since the case was with you since from 25th Aug-13 and you have asked several repeated documents queries on those days and the same has been satisfied subsequently to you on time to time. Is the Prior claim Intimation with Hospitalization's problem Information provided to you on 14Aug-13 when Mrs.Zeba was in hospital's bed with Claim IntimationNo-31583, Ticket No of Apollo Munich is:-666881. If yes, then why the Investigation happened and if happened why it happened post after hospitalization and also why the queries not raised in the Initial time?? On 4/09/2013 at 10:06 AM, your TPA FHPL has raised 1st Query Letter for 3 Queries, which has been answered/explained to you with the supporting documents via email, Acknowledgement also taken on next day ie.05/09/2013, Apollo Munich Call RefNo-674566. Is it true?? On 09/09/2013, subsequent calls has been raised by me to your Apollo Munich Call Centre to understand whether any more documents requires from my side or not. Apollo Munich Ticket No-666851, Where all the time on call, I have been committed that no more documents are requires now and we would process the claim. ..P.S:- the calls recordings are with me. On 13/09/2013 at 01:16 PM, since haven't received any response from your side to process the claim., I have raised complaint against your Team with FHPL Compalint-ID:-11038 and Apollo Munich TicketNo-682446. Why you haven't come that point of time that you were not able to process the claim??? Always you have provided me confirmation on phone that no more documents are required now and we would process the claim. When I enquired to you, you have sent me another Query Letter dated.13/09/2013 where you have asked me some more documents, the same supporting Documents would have been delivered to you on 14/09/2013. Also FHPL Sourabh Sehgal on phone has confirmed the same that no more documents requires now and we would process the claim asap. Is it true or not??? On 26/10/2013, you have raised one more Query Letter at 02:17 PM indicating 7 more Repeated query which has been satisfied you on 28/10/2013 via. email. The same has been intimated to Sourabh Sehgal also via email and also on phone. Is it true?? On 07/11/2013 at 04:10 PM, you have raised one more Query Letter in which you were asking for the same repeated query which has been satisfied you earlier. The same repeated documents ( 1 new query in that) would also have been delivered to you on 12/11/2013 and then the case has been escalated to Mr. Padmesh Nair... Is it true? On 14/11/2013 at 12:25PM, I have given one more Query Letter in which ALL the DOCUMENTS STATUS are in "RECEIVED" STATUS. The 14th Nov-2013 Query Letter has been provided to you as well subsequently. Is it true??? On 20th Nov-2013 at 11:30 AM, I have sent an email to [protected]@apollomunich.com with the details of 14th Nov-2013 Query Letter that All the DOCUMENTS are in "RECEIVED" STATUS, but the claim is not yet processed, then how suddenly after 1 hour, SAME "RECEIVED" Documents were in "PENDING" STATE. Is it true? yes, then how suddenly the same documents which were in "RECEIVED" state were converted to "PENDING" State. Please let me know the conspiracy here. On 2nd Dec-2013, Very cleverly and cunningly, you have closed my case, though the case was with [protected]@ApolloMunich via. Ticket No-741696. May I know the reason Why?? All the Documents were already received on 14th Nov-2013 Query Letter, then how suddenly the case has been closed without proper settlement. On 3rd Dec-2013, I have received a call from Mr. Narinder Bisht (from Apollo Greviance Team) for some of the repeated documents and I have agreed to provide the same once again. If you have already evaluated the case to constraint to get it settled, then how could Mr.Narinder would convince me to provide the relief on 3rd Dec-2013 Evening. P.S. The respective call recordings are with me. This behavior are definitely shows your intention in not resolving/settling the claim at all. Also since the case has been escalated to Mr.Padmesh Nair, you have closed my case... I want the full explanation on this, otherwise I would fetch everybody with their name in the court and provide them the Notice, since I have lots of proofs to justify my case... Regards Zeba C/O Mr Sameer Policy No-[protected] Cell:-[protected] On Fri, Dec 6, 2013 at 11:13 AM, grievance <[protected]@apo llomunichinsurance.com> wrote: Dear Mr. Sameer, Greetings from Apollo Munich. We have evaluated the case basis the documents already provided from your end and have observed certain discrepancies which have been highlighted to you in our previous communication . Basis the information/documents made available to us we are constraint to inform you that we would not be able to consider your request to settle the claim and same stands repudiated . However, in case you are not satisfied with our decision, you may approach the nearest Insurance Ombudsman for resolution of your grievance. The contact details of Ombudsman offices are available in the “Policy Wording” document. For any further assistance, please feel free to write back to us or reach us on our Helpline number:[protected]. Thanks & Regards, Vivek Manchanda Senior Executive ( Grievance Cell ) Apollo Munich Health Insurance Company Limited 10th Floor, Building No.10, Tower B, DLF Cyber City, DLF City Phase-2, Gurgaon-122002, Haryana Website - http://www.apollomunichinsurance.com From: Sameer K [mailto:[protected]@gmail.com] Sent: Thursday, December 05, 2013 3:52 PM To: grievance Cc: complaints IRDA; Padmesh Nair Subject: Re: ReminderNo-2: Re:Re:Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. 741, 696 Hi Narinder, As per our conversation on phone on 3rd Dec-2013 at 7pm, you have required some list of repeated documents once again and i have agreed to provide you the same. Please let me know the list of those documents, once again to provide you those repeated documents. Also for your reference, Pls find the same earlier harrassment story of[protected] of Apollo Munich Health Insurance's Harassment to Mr.Nikhil Kumar Shrivastava, by one of your sincere customers. pls read it... FYI below URL as well http://www.consumerforums.in/harassment-from-apollo-munich-health-insurance-comp...⇄ Regards Zeba C/O Mr Zeba Policy No-[protected] Cell:-[protected] On Mon, Dec 2, 2013 at 4:25 PM, Sameer K <[protected]@gmail.com> wrote: Hi Team, This is the gentle ReminderNo-2. How could your FHPL team has closed my Case:-139756 today at 1:25 PM, which was pending with you since from past 3 months and though it has not been resolved till now from your side.. Do you want me to file the case in Consumer Court or to file the IRDA complaints against you??? You people are disturbing me again and again by asking the same repeated documents, How many times do I have to sent you the same documents??? Please find the attached Query Letter dated 14th Nov-2013 in which all the pending documents were in "RECEIVED" STATE but as soon as i have shooted an email to your Greviance Team on 19th Nov-2013 morning, You cleverly sent me another 19th Nov-13 Query Letter in which some documents were in PENDING STATE. However, Last time, I'm attaching all the below 4 documents again for your reference which was raised by you in the trailing email and which is a repeated documents already provided you. Let me know if you are interested to face the Consumer Court. I won't let you go like this since I'm not a villager and would escalate it until i get the justice. Regards Zeba C/O Mr.Sameer Policy Number:-110103/11001/[protected] Cell:-[protected] [protected] Forwarded message[protected] From: grievance <[protected]@apollomunichinsurance.com> Date: Thu, Nov 28, 2013 at 1:04 PM Subject: RE: ReminderNo-1: Re:Re:Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. 741, 696 To: Sameer K <[protected]@gmail.com> Dear Mrs. Khan, Greetings from Apollo Munich. With reference to your below concern, we would like to inform you that as per our record the query letters which have been shared with the member contains the pendency details . We also note that still the pending documents are not made available to us. We have evaluated the case basis the information made available to us and would like to share the following observations: 1. We note that all indoor case records of the patients updated by a Single person. 2. Need for prolonged hospitalization is not established. 3. As per submitted Member declaration, all investigations done within the Hospital premises, however no laboratory found in the premises during the course of investigation/no clarification submitted by the Hospital. 4. Xerox copy of the Admission Register with patient details are not made available to us either during the course of Investigation / on raising a query. Hence, in view of above mentioned facts we are constraint to reiterate that the outcome of our review is consistent with our earlier observation / decision on your queries. For any further assistance, please feel free to write back to us or reach us on our Helpline number:[protected]. Thanks & Regards, Narender Singh Bisht Asst.Manager ( Grievance Cell ) Apollo Munich Health Insurance Company Limited 10th Floor, Building No.10, Tower B, DLF Cyber City, DLF City Phase-2, Gurgaon-122002, Haryana, INDIA. From: Sameer K [mailto:[protected]@gmail.com] Sent: Friday, November 22, 2013 12:17 PM To: grievance Cc: Sameer K Subject: ReminderNo-1: Re:Re:Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. 741, 696 Hi Team, Would you please let me know the reason of changing the status of all the ALL the DOCUMENTS which were in "RECEIVED" STATE as on 14th December-2013 Query Letter, TO the "PENDING STATE" in 19th Nov Query Letter at 2:49 PM, post after I shooted an email to you about 14th Nov Query Letter on 19th Nov-2013 at 11AM morning????? Regards Sameer (Zeba's Brother) C/O Zeba Policy Number:-110103/11001/[protected] Cell:-[protected] On Wed, Nov 20, 2013 at 5:45 PM, Sameer K <[protected]@gmail.com> wrote: Hi Team, You has sent me ALL documents status as "RECEIVED" on 14th Nov-13 Query Letter, letter was attached in trailing email and today again, after my trailing email, you have sent me 19th Nov-QueryLetter on which all the documents which was in "RECEIVED" status as on 14th Nov-2013, is in "PENDING" status as per New 19th Nov attached Query Letter received today at 02:49 pm. When all the documents was already in "RECEIVED" State as on 14th Nov-13 then how suddenly the same documents which was in "RECEIVED" state as on 14th Nov-13 can change to "PENDING" STATE, the instant i shooted a trailing email to you.? May I know the reason please??? Regards Sameer (Zeba's Brother) C/O Zeba Policy Number:-110103/11001/[protected] Cell:-[protected] On Wed, Nov 20, 2013 at 4:45 PM, grievance <[protected]@apollomunichinsurance.com> wrote: Dear Mrs. Khan, Greetings from Apollo Munich. With reference to your below concern, kindly note that the same is being examined by the concerned team. We assure you an appropriate response on the same 28-Nov-2013. Request for your patience during the processing time. Thanks & Regards, Vivek Manchanda Senior Executive ( Grievance Cell ) Apollo Munich Health Insurance Company Limited 10th Floor, Building No.10, Tower B, DLF Cyber City, DLF City Phase-2, Gurgaon-122002, Haryana Website - http://www.apollomunichinsurance.com From: Sameer K [mailto:[protected]@gmail.com] Sent: Wednesday, November 20, 2013 11:41 AM To: grievance Cc: Padmesh Nair Subject: Re:Re:Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. 741, 696 Hi Team, Kindly use your intelligence and don't blindly depend upon your sub-ordinate team since if they have done their task properly, i could not have reached Resp.Padmesh Sir... You was stating about the query letter dated. 11th Nov-2013 where some documents were in pending state, I don't understand what kind of due diligence, you have evaluated the case, Sorry to say this. I have received the Query letter dated 14th Nov-2013 from your Team only after submission of all the documents where it stated that all the documents have been in "Received" Status. Kindly find the attached query Letter dated 14th Nov. This is why the subject line marked as "ReminderNo-3" since the same documents which you stated below has already been sent to your concerned team at 3rd time of shortfall. Considering the below indicated queries raised by you numbering as Query No-1, 2, 3 and 4 respectively. Please find the attached documents once again for your kind perusal. Kindly let me know the ETA of the resolution of this IRDA issue... Thank you!!! Regards Zeba C/O Mr.Sameer (Zeba's Brother) Policy Number:-110103/11001/[protected] Cell:-[protected] On Tue, Nov 19, 2013 at 6:47 PM, grievance <[protected]@apollomunichinsurance.com> wrote: Dear Mrs. Khan, Greetings from Apollo Munich. With reference to your below concern, we would like to state that we have evaluated the case with due diligence and have noted that the said case is for management of acute gastroenteritis and the claimed amount is Rs.52000. However as per the information made available to us, we note that the same is on the higher side as compared to normal billing pattern of treatment of disease and infrastructure of hospital. Hence the case was triggered for investigation and the clarification given by the member during the investigation was not in line with the requirement raised at our end. While investigating we have noted discrepancy related to the time of admission and present complain. As per submitted declaration from the member complaint of high fever since midnight of 12-Aug-2013 however as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration. Hence a query was raised to provide the clarification on the discrepancy. Subsequently we have received the certain documents from the member, however the information/documents provided from customer was incomplete .Hence the query was raised again via letter dated 11-Nov-2013 to submit the required documents to process the claim as per terms and conditions of the policy. Further, we would like to clarify that the documents which you are referring to in your previous mail have already been received from your end except the ones where the clarification was required for the discrepancy raised in the query letter. We still await the following documents which are not made available to us and which are essential for evaluation and further processing of the claim . Hence, we request to you to please submit the same at the earliest so that we can process the claim as per terms and conditions of the policy. For any further assistance, please feel free to write back to us or reach us on our Helpline number:[protected]. We candidly submit above resolution against your complaint. You may acknowledge the receipt of this mail and confirm about the closure of the case. We shall regard the complaint as closed if we do not receive a reply within 8 weeks from the date of receipt of response by the insured /policyholder. Please refer the Policy Wordings and /or visit our website www.apollomunichinsurance.com to know the “Grievance Redressal Procedure”. Thanks & Regards, Narender Singh Bisht Asst.Manager ( Grievance Cell ) Apollo Munich Health Insurance Company Limited 10th Floor, Building No.10, Tower B, DLF Cyber City, DLF City Phase-2, Gurgaon-122002, Haryana, INDIA. From: grievance Sent: Thursday, November 14, 2013 12:05 PM To: '[protected]@gmail.com' Subject: RE: Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. 741, 696 Dear Mrs. Khan, Subject: Acknowledgement of your query We acknowledge your complaint received via mail regarding “Delay in claims settlement”. Your complaint number logged dated 13-Nov-2013 is 741, 696. Your IRDA token no.[protected] . We assure you an appropriate response maximum by 19-Nov-2013. In case, you do not hear from us within this time period, feel free to call us on our 24/7 customer helpline number[protected]. Please refer the Policy Wordings and /or visit our website www.apollomunichinsurance.com to know the “Grievance Redressal Procedure”. Do remember to quote the case number mentioned above for ease of identification. We look forward to providing you uncomplicated health insurance services. Thanks & Regards, Vivek Manchanda Senior Executive ( Grievance Cell ) Apollo Munich Health Insurance Company Limited 10th Floor, Building No.10, Tower B, DLF Cyber City, DLF City Phase-2, Gurgaon-122002, Haryana Website - http://www.apollomunichinsurance.com From: "Sameer K" <[protected]@gmail.com> To: "Padmesh Nair" <padmesh.[protected]@apollomunichinsurance.com> Cc: "[protected]@irda.gov.in" <[protected]@irda.gov.in> Subject: Fwd: Fwd: Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Dear Padmesh, FYI and FYA trailing email People are giving their hard earned money for Medical Insurance premium in thought that the Insurance company will help them at the time of emergency but if they do like below acts then nobody will take the insurance from now onwards. As per below trailing email, This has crossed every limit and your team were playing with me since from past 2.5 months and not at all processing the claim and asking the same repeated documents again and again which they have already received earlier. You can see the documents which they asked has already been provided, see below explanation:- **Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration. 5 As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. 51149 Received Mandatory But your team is still looking for this document now also. **Please provide the Xerox copy of admission register with detail of your admission. 3 Please provide the Xerox copy of admission register with detail of your admission. 51149 Received Mandatory Since it already been received by your team, but they still looking for this document now also. Also all other documents were delivered by me to your Team on time to time for further processing of the claim but still there is no response instead they are playing with me like below that " we require this documents again for further processing of the claim". I'm very irritated and proceed to file the Case in consumer court though i thought to get it produce infront of you to get the needful. Hope to get the positive response from your side on this and soon my Sister Zeba's claim would process. Thank you! Regards Sameer(Zeba's Brother) C/O Zeba Policy Number:-110103/11001/[protected] Cell:-[protected] [protected] Forwarded message[protected] From: Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com>> Date: Wed, Nov 13, 2013 at 5:16 PM Subject: Re: Fwd: Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. To: Sourabh Sehgal <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> Cc: Grievances <[protected]@fhpl.net<mailto:[protected]@fhpl.net>>, info <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> Hi Sourabh, Thanks for your help. Let us play in the court now. You have already received this document as per earlier email. **As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. Received by you earlier on 8th Nov-2013 **Please provide the Xerox copy of admission register with detail of your admission. This also you received. But you are playing with me and the patient. No need to process the claim, it will done by the Court now. Thanks all for your service. @Greviance Team, Thanks for your muteness, you all have to pay for this legally now. Thank you! Good Bye and See you soon! Regards Sameer(Zeba's Brother) On Wed, Nov 13, 2013 at 4:52 PM, Sourabh Sehgal <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> wrote: Dear Mr. Sameer, This is to inform you that, we have reviewed the case below with our Medical Experts & evaluated that, yet we have not received : **All treatment records prior to hospitalization. **Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. **Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration. **As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. **Please provide the Xerox copy of admission register with detail of your admission. Please arrange to provide us the same for further review. Regards, Sourabh From: Sameer K<mailto:[protected]@gmail.com> Sent: Tuesday, November 12, 2013 10:57 AM To: Grievances<mailto:[protected]@fhpl.net> ; Sourabh Sehgal<mailto:[protected]@fhpl.net> Cc: info<mailto:[protected]@fhpl.net> ; Sameer K<mailto:[protected]@gmail.com> Subject: Fwd: Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Dear Grievance Team and Sourabh, Please confirm the acknowledgement of this Six documents sent to you yesterday for further processing of the claim as discussed and agreed on phone. Can you pls confirm the same as an acknowledgement?? You must have to provide an acknowledgement without being asked by the customer. Thank you! Regards Zeba Policy Number:-110103/11001/[protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]> [protected] Forwarded message[protected] From: Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com>> Date: Mon, Nov 11, 2013 at 5:22 PM Subject: Re: Reminder No-3:-ClaimID : 139756 : Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. To: Sourabh Sehgal <[protected]@fhpl.net<mailto:[protected]@fhpl.net>>, Grievances <[protected]@fhpl.net<mailto:[protected]@fhpl.net>>, info <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> Cc: Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com>> Subject:-"Very Last Documents from my side to You for further processing of the claim" Hi Grievance Team and Sourabh, This has crossed the limit and again your Team has asked me the repeated documents again and again.Please advise them not to play with customers. They have sent one more additional info documents, shortfall letter to me on 7th Nov-2013. (letter attached for your reference) and also as described by Sourabh in the trailing email. This is the last time, I'm providing you the below attached repeated and the NEW documents once again to process the claim as agreed to Sourabh on phone. Please find the attached old and new documents for your reference and further processing of the claim. Thank you! 1).Query No-2 Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration 51149 Pending Already given this documents to your team and provided the clarification from the doctor as well on letter head.. why they want the customers to get irritate and to take some actions. Anyway Please find the attached clarification on doctor letter head once again now from Mahesh Hospital. Kindly do the needful. 2.) QueryNo-4 All treatment records prior to hospitalization. 51149 Pending Mandatory Declaration from Zeba has already being provided on her writing that "No Treatment has been done" prior to hospitalization with the self signature on paper and also the declaration provided on Mahesh hospital's letter head about that "No Treatment of Zeba has been done prior to hospitalization". Please find the same. 3.) QueryNo-7 Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. 51149 Pending Mandatory Attached Hospital registration papers has been attached for your reference now. Also the given number of beds, OT etc details has been provided on Hospital Letter Head now from Hospital. 4.) QueryNo-9 Treating doctors certificate for clarification, As per submitted indoor case papers member was afebrile after 16 aug, then why patient was kept for another two days. 51149 Pending Mandatory This is the new documents your Team is looking for, why again and again, Do they take 10 years to process the claim?? Already all the Indoor case papers has been provided to them then why they are looking for 16 aug. indoor case papers. Anyway, the require documents clarification on Hospital Letter Head is attached for your reference, Please find the same and do the needful. Kindly consider and do the needful. Even after satisfying all this queries now 3rd time, if the claim would be pending for some more clarification then I would think it that you don't want to process the claim and will take the further necessary steps. Hope the attached documents would clarify all the queries of your team which they have raised it 3rd time.. Regards Zeba Policy Number:-110103/11001/ [protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]> On Mon, Nov 11, 2013 at 4:13 PM, Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com>> wrote: Could you please give me the call now to discuss?? Haven't received the call... On Mon, Nov 11, 2013 at 12:38 PM, Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com>> wrote: Why you are giving missed call man! Give me a call now, I was about attend and it was disconnected at your end... If you are done this intentionally to make sure from your end that i have been called, then your team is also doing it right way!!! I agree on that... Regards Sameer On Mon, Nov 11, 2013 at 12:27 PM, Sourabh Sehgal <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> wrote: Dear Mr. Sameer, We have tried to get in touch with you, but no. was not connected. So keep in touch @[protected] to discuss the case further. Regards, Sourabh From: Sameer K<mailto:[protected]@gmail.com> Sent: Monday, November 11, 2013 11:20 AM To: Sourabh Sehgal<mailto:[protected]@fhpl.net> Cc: Grievances<mailto:[protected]@fhpl.net> ; info<mailto:[protected]@fhpl.net> Subject: Re: Reminder No-3:-ClaimID : 139756 ::: Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Hi Sourabh, How many times, I was and will agreed to provide you the repeated documents needed to process the claims. Please let me know numbers... I was talking you about the repeated documents and hence in this regard, you asked me to send those repeated documents again to you which i have already sent it to your Team. Give me a call, would like to discuss and close it, I'm really irritated and frustrated with your team's irresponsible behaviour. Regards Sameer (Zeba's Brother) Cell:-[protected]<tel:[protected]> On Mon, Nov 11, 2013 at 10:00 AM, Sourabh Sehgal <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> wrote: Dear MR. Sameer, This is to inform you that, the case has been reviewed on the basis of provided documents, but yet we have not received few pending docs (as mentioned below) : SLNo Bill No Particulars of Details / Documents Required Amount Status Requirement Type 1 All indoor case paper written in single stretch of handwriting as proof of admission and received treatment for five days, please provide the clarification from medical superintendent of hospital with sign and stamp. 51149 Received Mandatory 2 Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration 51149 Pending Mandatory 3 Please provide the Xerox copy of admission register with detail of your admission. 51149 Received Mandatory 4 All treatment records prior to hospitalization. 51149 Pending Mandatory 5 As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. 51149 Received Mandatory 6 Attested copies of indoor case papers of hospitalization including admission notes and daily progress notes. 51149 Received Mandatory 7 Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. 51149 Pending Mandatory 8 Previous treatment records prior to hospitalization including 1st consultation letter of HTN. 51149 Received Mandatory 9 Treating doctors certificate for clarification, As per submitted indoor case papers member was afebrile after 16 aug, then why patient was kept for another two days. 51149 Pending Mandatory 10 Treating doctors certificate for Past history duration of HTN When diagnosed for the 1st time. 51149 Received Mandatory And also you were agreed on call to arrange the require pending documents for further processing of this case. Regards, Sourabh From: Sameer K<mailto:[protected]@gmail.com> Sent: Saturday, November 09, 2013 9:23 PM To: Grievances<mailto:[protected]@fhpl.net> ; Sourabh Sehgal<mailto:[protected]@fhpl.net> Cc: info<mailto:[protected]@fhpl.net> ; Sameer K<mailto:[protected]@gmail.com> Subject: Reminder No-3:-ClaimID : 139756 ::: Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Hi Greviance Team, Reminder No-3, FYI and FYA, @Hi Sourabh, As discussed on phone today, This is the third time your team has place the 3rd Shortfall after 2.5 months of the case pending with them. We have also discussed at the time of 1st shortfall before 2 months back and the same 3 requirement has been satisfied to your team. Then after 2 months of case pending with your team, they have again come back with 7 more documents which and when Greviance Team involved in that, i have sent them 7 more documents last time to your team through Greviance team. Now your team has satisfied 4 requirements, and now at 3rd time, they are again looking for the 3 repeated documents clarification along with the 1 more new shortfall. Please let me know why your Team is looking for the same repeated documents again and again to process this claim after 2.5 months of the case pending with them... Please ask your team and let me know the clear intention of your team whether they want to process the claim or not, irritating the customer doesn't good for the service providers any time...Hope you understand. Thank you! Note:- Please don't change the subject line of this email correspondence since it can be used in future prospects. Regards Zeba Policy Number:-110103/11001/ [protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]><tel:[protected]<tel:[protected]&g...⇄ On Tue, Nov 5, 2013 at 9:17 AM, Grievances <[protected]@fhpl.net<mailto:[protected]@fhpl.net>> wrote: Dear Sir/Madam, Greeting’s from Family Health Plan (TPA) Limited, We have forward the documents to concern department and will update the status at the earliest. Should you need any further assistance, please write to us.We will be more than happy to be of service to you. Thanking you and assuring you of our best services at all times. Regards [protected]@fhpl.net<mailto:[protected]@fhpl.net> ________________________________________ From: Sameer K [[protected]@gmail.com<mailto:[protected]@gmail.com>] Sent: 04 November 2013 18:03:32 To: Grievances; info Cc: Sameer K Subject: Reminder No-1:-ClaimID : 139756 ::: Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Hi Grievance Team, As below explanation already provided to you for the clarification of the pending documents, Anyway providing you all those old and new documents once again to you for your kind perusal. Please find the attached copy of the documents taken from the hospital for the further processing of the claim. Its was too hectic to get all this certificate from the hospital and inspite of your investigator already visited, your Team asked me this documents again and again. Anyway, All the required documents are now with you for further process. Kindly do the needful and process the claim asap. Thank you! Note:- Please ask your team not to disturb us again and again for this case as already we have been tortured by you since from past 2.5 months. This is the last help from my side to you. Hope you understand. Thank you! Regards Zeba Policy Number:-110103/11001/ [protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]><tel:[protected]<tel:[protected]&g...⇄ On Fri, Nov 1, 2013 at 5:27 PM, Sameer K <[protected]@gmail.com<mailto:[protected]@gmail.com><mailto:[protected]@gmail.com<mailto:[protected]@gmail.com>>> wrote: Hi Greviance Team, Do you think that I don't understand English. This queries has been raised after 2 months, since the case was pending with you, Could you please let me know your SLA of processing?? As already specified the Indoor case papers, hospital registration papers has already been provided to you and also Investigation has been done from your side though we have already pre-intimated you about the hospitalization of Zeba. If the Investigation happened, then what's the Investigation done by your Investigator, why he hasn't asked the details of Hospital Registration Papers, Hospital Register sheets etc and why he hasn't seen the upper floor of the Hospital where the Pathology Lab located which is the Hospital Lab only. Now I'm very much irritated because of your Team's irresponsible behaviour and doesn't like to send even a single document to you but I would help you here in below queries last time prior to approaching higher officials. 1 All indoor case paper written in single stretch of handwriting as proof of admission and received treatment for five days, please provide the clarification from medical superintendent of hospital with sign and stamp. 51149 Pending Mandatory ALL Indoor Case papers were being provided to you on letter pad of the Hospital, I don't understand what else has been requires now. 2 Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration, please provide the clarification from hospital. 51149 Pending Mandatory Can't the patient have the vomiting and dehydration the next day of fever, what is this, Why your Team are playing with customers? Kindly let me know what clarification requires. 3 Please provide the Xerox copy of admission register with detail of your admission. please provide the same from hospital 51149 Pending Mandatory IT was a plain register of the hospital, your Investigator can also take that xerox of that papers from the hospital, whats the Investigation he has done there, I'll try to take the xerox of the admission register paper from hospital and would try to provide it to you. 4 All treatment records prior to hospitalization. please provide the same at your end. 51149 Pending Mandatory Insured Zeba has already provided the declaration that no treatment has been done prior to hospitalization then what is the meaning of asking it again?? Do you think the answer would be change if your Team asked the same documents again and again. Please clarify and educate your team on this. 5 As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. 51149 Pending Mandatory Why the Investigator has overlooked the upper floor of the hospital where the Hospital Pathologists Labs were present, Don't understand why your team is torturing the customers like this and what your Investigator has done there while approaching hospital??? 7 Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. please provide the same from hospital 51149 Pending Mandatory This Hospital Registrator paper has already been provided, will provide the Xerox to you once again. Now, I have tried to help you here once again, If your Team again disturbing me then I won't reach you promise, I'll reach to Consumer court to resolve this problem. Thank you! Regards Zeba Policy Number:-110103/11001/ [protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]><tel:[protected]<tel:[protected]&g...⇄ On Fri, Nov 1, 2013 at 4:08 PM, Grievances <[protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected...⇄ wrote: Dear Sir/Madam, Greeting’s from Family Health Plan (TPA) Limited, Please send the below documents for further process of the claim. SLNo Bill No Particulars of Details / Documents Required Amount Status Requirement Type 1 All indoor case paper written in single stretch of handwriting as proof of admission and received treatment for five days, please provide the clarification from medical superintendent of hospital with sign and stamp. 51149 Pending Mandatory 2 Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration, please provide the clarification from hospital. 51149 Pending Mandatory 3 Please provide the Xerox copy of admission register with detail of your admission. please provide the same from hospital 51149 Pending Mandatory 4 All treatment records prior to hospitalization. please provide the same at your end. 51149 Pending Mandatory 5 As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. 51149 Pending Mandatory 6 Attested copies of indoor case papers of hospitalization including admission notes and daily progress notes. 51149 Received Mandatory 7 Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. please provide the same from hospital 51149 Pending Mandatory 8 Previous treatment records prior to hospitalization including 1st consultation letter of HTN. 51149 Received Mandatory 9 Treating doctors certificate for Past history duration of HTN When diagnosed for the 1st time. 51149 Received Mandatory Should you need any further assistance, please write to us.We will be more than happy to be of service to you. Thanking you and assuring you of our best services at all times. Regards [protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected]@fh...⇄ [protected][protected][protected] From: "Grievances" <[protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected...⇄ Sent: Tuesday, October 29, 2013 11:18 AM To: "Delhi AMHI" <[protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected...⇄ Cc: "Raman KT." <[protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected...⇄ "Namrata Saraswat" <namrata.[protected]@fhpl.net<mailto:namrata.[protected]@fhpl.net><m...⇄ Subject: FW: ClaimID : 139756 ::: Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Dear Team, Pls find the below mail & revert with updated status Regards [protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected]@fh...⇄ ________________________________________ From: Sameer K [[protected]@gmail.com<mailto:[protected]@gmail.com><mailto:[protected]@gmail.com<mailto:[protected]@gmail.com>>] Sent: 29 October 2013 10:54:53 To: Grievances Cc: Sameer K Subject: Re: ClaimID : 139756 ::: Zeba Khan---Case was pending since from 2 months and 7 more queries has been raised now. Dear Grievance Team, Please find the attached earlier email with you for your reference. This case was pending with your Team since from 24th August-2012 and i have provided all the documents to them for the very Ist shortfall only and received the response that the case would be resolved soon. But after 2 months (ie.from Aug to Oct-13), Your Team has come back to me with the below 7 more queries which is nothing but to unnecessarily disturbing customers with their bad intentions. I'll explain you how they are irritating customers as below... 1) All indoor case paper written in single stretch of handwriting as proof of admission and received treatment for five days, please provide the clarification from medical superintendent of hospital with sign and stamp. 51149 Pending Mandatory This documents has already provided to your concerned team and they have confirmed the same after receiving but they are unnecessarily torturing customers by asking it once again that too after 2 months of the case pending with them 2) Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration 51149 Pending Mandatory I didn't understand this shortfall that too after 2 months of the case pending with them, if the person is having fever one day before hospitalization and if they have loose motions next day then what was the issue in that and what will be given to prove if the discharge certificate and hospital papers already stated that. Why your Team is disturbing us that too after 2 months of the case pending with them??? 3) Please provide the Xerox copy of admission register with detail of your admission. 51149 Pending Mandatory All treatment records prior to hospitalization. 51149 Pending Mandatory Really surprising, i have already submitted the Xerox copy of the registration papers of the hospital then asking again for it, not shows a clear intention. Also I came to know that Investigator has visited the Hospital, then what investigation has been happen, why he hasn't asked for that documents from hospital.. Treatments records prior to hospitalization has already been, provided the declaration by the Insured (Zeba) on paper and your Team has received that as well, then what is the intention of asking it again???? This all questions is coming to my mind relating to the processing of the claims and intention of your Teams in processing the claims. I'll looking forward from you to look into this and do the needful for processing of the claims, failing so will allow me to place it to the higher government officials. Thank you! Its looks like i have made a big mistake while taking Apollo Munich Medical Policy...and have a small hope that you would do the needful. Regards Zeba Policy Number:-110103/11001/[protected] c/0 Mr Sameer Cell:-[protected]<tel:[protected]><tel:[protected]<tel:[protected]&g...⇄ On Sat, Oct 26, 2013 at 2:17 PM, <[protected]@fhpl.net<mailto:[protected]@fhpl.net><mailto:[protected...⇄ wrote: FHPL-CL-FT-02 Date: 26 Oct 2013 Name of the insurer Name of the Insured Apollo Munich Health Insurance Co. Ltd. Zeba Khan Name of the Policy Holder Hospital Name Zeba Khan Mahesh Multispeciality Hospital and Trauma Centre Policy No Claim Type UHID No Employee ID 110103/11001/[protected] MR [protected] Claim ID PA No Date of Admission Date of Discharge 139756 13 Aug 2013 18 Aug 2013 Corporate Name : Dear Sir/Madam, With reference to the above claim, we verified the documents submitted by you and we observe that below mentioned details / documents are required to process the claim further. Bill No Particulars of Details / Documents Required Amount Status Requirement Type All indoor case paper written in single stretch of handwriting as proof of admission and received treatment for five days, please provide the clarification from medical superintendent of hospital with sign and stamp. 51149 Pending Mandatory Discrepancy noted in time of admission and presenting complain (as per your statement high fever since midnight of 12.08.2013 but as per hospital records complaints of watery loose motions since morning with vomiting, ghabrahat and dehydration 51149 Pending Mandatory Please provide the Xerox copy of admission register with detail of your admission. 51149 Pending Mandatory All treatment records prior to hospitalization. 51149 Pending Mandatory As per your statement all tests were conducted inside the hospital, but on checking the hospital there no laboratory could be found by us, please share the detail of pathologist name and registration detail. 51149 Pending Mandatory Attested copies of indoor case papers of hospitalization including admission notes and daily progress notes. 51149 Received Mandatory Hospital registration papers with detail of number of beds in Hospital, OT, nursing staff and RMO detail. 51149 Pending Mandatory Previous treatment records prior to hospitalization including 1st consultation letter of HTN. 51149 Received Mandatory Treating doctors certificate for Past history duration of HTN When diagnosed for the 1st time. 51149 Received Mandatory All above documents should be submitted in original. Please submit the documents within 15 days of receipt of this letter and quote the Claim ID for all future correspondence regarding the claim. *Mandatory Documents: The claim will be closed if the documents are not submitted with in stipulated period **Non Mandatory Documents: The claim will be processed and paid after deducting the amount mentioned against the required document in the above list if not submitted. Please also be noted that further to this letter we will be sending 2 reminders before closing the claim if documents are not received/submitted in the stipulated period. Please Call on [protected]<tel:[protected]><tel:[protected]<tel:[protected]>>...⇄ (TollFree) for any assistance. 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Apollo Munich Health Insurance Company Limited is not responsible for the damage, if any, caused by a virus or alteration of the e-mail by a third party or otherwise. The information in this electronic mail including any attachments is confidential in nature and may be legally privileged and is for the exclusive use of the intended recipient(s). Any disclosure, review or reliance by others or copying or distribution or forwarding of any or all of the contents in this message and attachments or taking any action based on it, is strictly prohibited. If you are not the intended recipient(s), please contact the sender by email and delete all the copies. The recipient(s) acknowledges that the contents of the e-mail and the attachments may not necessarily represent the views and policies of Apollo Munich Health Insurance Company Limited. Before opening any attachment, please scan for any viruses and the defects. 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Apollo Munich Health Insurance Company Limited is not responsible for the damage, if any, caused by a virus or alteration of the e-mail by a third party or otherwise. The information in this electronic mail including any attachments is confidential in nature and may be legally privileged and is for the exclusive use of the intended recipient(s). Any disclosure, review or reliance by others or copying or distribution or forwarding of any or all of the contents in this message and attachments or taking any action based on it, is strictly prohibited. If you are not the intended recipient(s), please contact the sender by email and delete all the copies. The recipient(s) acknowledges that the contents of the e-mail and the attachments may not necessarily represent the views and policies of Apollo Munich Health Insurance Company Limited. Before opening any attachment, please scan for any viruses and the defects. Apollo Munich Health Insurance Company Limited is not responsible for the damage, if any, caused by a virus or alteration of the e-mail by a third party or otherwise. The information in this electronic mail including any attachments is confidential in nature and may be legally privileged and is for the exclusive use of the intended recipient(s). Any disclosure, review or reliance by others or copying or distribution or forwarding of any or all of the contents in this message and attachments or taking any action based on it, is strictly prohibited. If you are not the intended recipient(s), please contact the sender by email and delete all the copies. The recipient(s) acknowledges that the contents of the e-mail and the attachments may not necessarily represent the views and policies of Apollo Munich Health Insurance Company Limited. Before opening any attachment, please scan for any viruses and the defects. Apollo Munich Health Insurance Company Limited is not responsible for the damage, if any, caused by a virus or alteration of the e-mail by a third party or otherwise. The information in this electronic mail including any attachments is confidential in nature and may be legally privileged and is for the exclusive use of the intended recipient(s). Any disclosure, review or reliance by others or copying or distribution or forwarding of any or all of the contents in this message and attachments or taking any action based on it, is strictly prohibited. If you are not the intended recipient(s), please contact the sender by email and delete all the copies. The recipient(s) acknowledges that the contents of the e-mail and the attachments may not necessarily represent the views and policies of Apollo Munich Health Insurance Company Limited. Before opening any attachment, please scan for any viruses and the defects. 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