Apollo Munich Health Insurance Complaints & Reviews

I, jyoti agarwal, wife of shashwat agarwal, holding a policy, no. ;- 110102/11121/AA00044668 would like to complaint against the mental harrasment, being caused from, due to the denial of cashless claim. My husband who is the only earning member of the family, has had a terrible accident, and he is being treated at Max hosp. Saket since 8th of oct. He has had partial disability and in such a grave situation, i desperately need this cashless claim of Rs. 6Lacs as promised by your insurance advisor, otherwise the medical treatment required for my husband wont be possible. kindly help me in this hour of need.

Dear Sir, This is to inform you that I have registered the policy from Apollo munich . Policy No.110105/11121/[protected]-01 and ID is [protected]. I have admitted to my son in the hospital.e When I asked for cashless facility from them, they have rejected my request. When I calls them they are not picking up my phone and when picked up then did not respond positivly.I have provided the letter which is written by Hospital doctor on which mentioned that patient cannot be admitted on OPD basis still they are asking that patient have to admit on opd basis. Please suggest how I arrange money for my son now. please help me to provide the insurenced money. Thanks Deepak Shah deepak.[protected]@rwbigelife.in contact: [protected]

HI, In regards to Claim ID - 213747 Claim not settled even after 2 months. I want to share my experience about Apollo munich, this is pathetic health insurance company I had seen in my life. I was a regular premium paid customer of the company and had paid premium for 4 years. After 4 year when at the time of need I required cash less hospitalization Apollo munich had not clear the cash less treatment at hospital. Then I had send for claim reimbursement with all original documents, but From last 2 months I am trying to get my claim reimbursement, every time the day they mention will clear the case and I will get my money, on that day I get one mail from grievance where they gave me new date and 2nd mail from claim department about the same paper which I had send 2 months back. 2 times I had visited hospital again and they had given my original copies of bills again which I had send to insurance company, but still same pendency they are showing. I don’t know what they want, but nothing helping even I had send mail to their ceo for help, but even after it no one is helping in the organisation and claim still not clear. Regards Kunish [protected] Policy No 110100/11051/[protected]-02 Claim ID - 213747

I Sandeep Bakshi having claim id no 217714 deposited my all original documents by hand in Pitampura apollo Munich branch and on 18th Sept they asked me to send cancelled cheque i send it on 22nd Sept. After that they said money will be transferred to Ur account in 1 or 2 days. Same statement was given to me till 30th Sept. But on 1st October they asked that Ur 5 documents are pending as all these documents are submitted by me on 8th Sept.by hand .
But they are saying that we didn't received these documents
please take some action against tham?

The Company rejected cash less Stating that Justification for the need of admission from the doctor, Above all the hospital is renowned and on Panel of the Insurance company. It seems they want me to approach insurance first and then trust doctor for need of hospitalization. Hospital Name- MAX Saket Insurer--Apollo Munich. They called to tell me that i have Diabetes and Hypertension that why claim was rejected whereas nothing that is true nor existing!!! They are very rude and since last 3 months no one called me after repeated requests.Hardly reply to mails. Got reply only after writing to CEO, that also revert by very unprofessional staff.

Sir, I the undersigned a undisputed policy holder with high credentials and social responsiability of your Esteemed Company “THE APOLLO MUNICH” under Medi claim policy since 4 years with sum assured of Rs.4.00 Lacs covering myself, My wife and My two children .The related premiums have been paid promptly without any delay and with NIL Claims as on to date. On Saturday 13 September 2014 about 5.30 P M my wife Dr Saritha Mahesh B G developed high fever with temperature of 102*F, chills, severe body ache, Head Ache and Joints pain with Vomiting and she was not in status of getting up by herself .As doctor by profession she took tablets for fever and body ache . On Sunday 14 September 2014, about 10.30 AM in the morning same continued to persist, we immediately rushed to our family physician, who advised us to take her to the nearby hospital because the symptoms were similar to Dengue . Upon the advice of our family physician we rushed to M/s VIKRAM HOSPITAL cunnigham road Bangalore around 11.15 AM, The duty doctors of M/s VIKRAM HOSPITAL outpatient department conducted the preliminary investigations and verifying the vital Parameters and patient status advised us to admit her. By 1.30 pm she was admitted with initial security deposit of Rs.5000.00 and the necessary insurance documents were provided under ID 143832/1 .We were informed by evening from the respective officials of M/s VIKRAM HOSPITAL that our insurance claim is under process and they also informed the necessary queries raised by Esteemed organization have been attended immediately. We were shocked to hear that our claim has been rejected under cashless scheme . The so called esteemed “THE APOLLO MUNICH’ officials were least bothered to resolve the issue and they were interested in out rightly rejecting the claim under cashless scheme. The officials were not interested in looking the credentials of the policy holder under what circumstances the claim has been raised there by putting the prompt policy holder under hardcore ship of difficulties . The so called esteemed “THE APOLLO MUNICH’ has the provision to depute its official/Agents for collecting the premium from the doorstep up of residence of policy holder but they do not have any provision nor interest in verifying the status under what circumstances the patient was made to admit, if the documents provided by the concerned officials of the Hospital were not satisfactory . Under these circumstances I wish to bring to your kind notice that iam not interested in claiming the claimed amount under reimbursement facility and wish to donate the entire amount to charity which might be utilized as per the companies requirement I once again like to thank TEAM “THE APOLLO MUNICH’ for supporting me under difficult times Aggrieved policy holder

Dear Sir, I was in a wrong notion that Appolo Munchwill be one of the best insurance company which will provide better service tothere customers, but to my surprise it was a very very bad experience. I have gone for two health insurance ( i.e2+2 & 2+1 ) to my sister family on 27/07/14 for Rs.15246/- paid by my CC, its nearly 45 days, till date we have not received documents or call from urside. I have contacted the agent in this regard but no proper responce. Details given below :- 1) A. SUDHINA[protected] A.VIRAT[protected] A.VIVANTHA[protected] 2 ) A . MALLIKARJUN[protected] A. LEETESH[protected] Kindly expedite the same at the earliest, and also the procedure to cancel the policy. regards M.Sudhir Kumar Mob : - [protected].

Respected sir,

Irda token number[protected]
Jagdish kumar suneja-policy no.[protected])

I met with an accident on 9 march and informed company during hospitalization submitted documents in april. In may a investigator mr.Gurnam singh came from delhi to verify documents and doctor records and demanded under table which i refused to pay results of which he submitted company un complete documents company demanded documents which sent to company

Now when company have no option to pay claim. He is demanding documents already submitted.

Point wise reply to all letters / email dated 13.05.2014, 10.06.2014 & 02.07.2014, 21.07.2014 and 07.08.2014.

In last letter dated 07.08.2014, company told no coperation from treating doctor and ask to arrange meeting with doctor which was arranged on 25.08.2014 at 1 pm and mr.Sanjay sharma from lawman associates (Investigator of company) came and checked original records of doctor and collected pointwise reply from doctor on the queries and signed with no more queries left.

Company is continuous avoiding from april. In his email dated 26.08.2014, company committed that there will be final response upto 29.08.2014 but again they send email on 29.08.2014, they need more time to review reports.

If company has not received co-operation from doctor why not intimated in previous letters/email. After 4 monthscompany sayin g doctor not co-operating it is not logic.

Kindly do the needful against apollomunich health insurance company limited.

With regards


Jagdish kumar suneja
[protected]

Enclosed: emails correspondence done with company and documents submitted to company hard copies at its ludhiana office.

[protected]@irda.Gov.In
Dear .Jagdish suneja,


Complaint with irda token number[protected] and entity reference number 108117 has been escalated successfully


Grievance

To me


Dear mr. Suneja,
Greetings from apollo munich.
With reference to your below mail, we would like to inform you that we have got the reinvestigation done on the case and waiting for the final complete report from the investigator.
Post review of the reports we shall be able to share our final decision on the admissibility of the claim as per policy norms.
Request for your patience during the processing time.
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 redressal cell )
Apollo munich health insurance company limited
2nd & 3rd floor, ilabs center, plot no.404-405, udyog vihar, phase-3
Gurgaon -122016, haryana
________________________________________________________________________________...⇄
From: grievance
Sent: tuesday, august 26, 2014 3:47 pm your
To: 'angel suneja'
Subject: re: case id 1075080 policy no [protected]-04

Dear mr. Suneja,
Greetings from apollo munich.
With reference to your below mail, we would like to inform you that basis the details shared by you, we shall contact the treating dr to acquire the required information on subject matter . We shall share our final response maximum by 29-aug-2014.
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 redressal cell )

i have submitted my claim documents on 24 june and as per the apollo munich's policy, they help us out within 21 working day or maximum 45 days. But its been 60 days n we have not yet received even a single confirmation that our documents which we have sent through DTDC SERVICE is received by them or not. Its highly disgusting to experience such a service where we are constantly receiving letters that our documents are incomplete just because there is a poor management in there department where they are not able to even coordinate with each other properly. Its a constant humiliation for my family because this so called company NAMED APOLLO MUNICH is not able to handle documents properly. They are making it so complicated n miserable for us to get get our claim money which is nothing but our money paid to them. I would never suggest anyone to get the insurance from APOLLO MUNICH

Hi, This email is to inform you that Apollo Munich customer service is pathetic and I am not happy with the service. They always make false commitments. I have an individual insurance policy with Apollo Munich for last 4 years. I got married this year on the month of January so I wanted to add my wife name to my insurance policy until the renewal date. As I wanted to change my individual policy to a floaters policy so I called your customer service and they told me that I would not be able to change my individual policy to floaters until my policy renewal date.I called the customer service many times and they told me that I would need to download a proposal form from Apollo Munich website to add my wife name to my policy until my policy is renewed and they said that some one would come to my place to collect the document and fee. I downloaded the proposal form and call the customer service again so that they can someone to collect the required documents and the fee to add my wife name to my policy. They promised me yes someone would can to my place. I waited for almost a week then I called back again and second time also I was promised that a rep. would be sent to collect the document but no one came. It is almost a month and no one called me nor no one came to my place to collect the document.My call reference number is -997212, 977764, 977557. Note- I think I should cancel the service with Apollo Munich. Please look into the matter as it would impact the reputation of the company. Thanks, Monirul

i vinod bhasin ([protected]) contact lots of time to Apollo Munich customer care dept. Actually my wife have the health policy of apollo munich. and i put the request they please add me and my son on this policy but i didnt get the response. every time they say tomorrow our person will contact you but from the last 2 MONTH no one contact me. Even today is the last day of renewal of my wife policy but no response from your side. APOLLO MUNICH IS THE WOREST COMPANY IN MY POINT OF VIEW. BECAUSE CUSTER WANT TO JOIN YOU ARE NO RESPONSING HOW COULD YOU SETEL THE CLAIM EASILY.

I am Jyotirmaya Mishra, Member ID - [protected] had applied for reimbursement for my wife (Rajalaxmi Mishra) & daughter (Samiksha Mishra) on 3rd of June 2014 but till date i don't get any satisfactory reply from the agency. On the date of 19th June 2014, i had a mail from the Claim department that i have not attached the cancelled cheque with the document. So on the same date i have sent cancelled cheque through mail. Then on 22th June, i had a new mail that i have to submit attested copies of indoor case papers of hospitalization including notes and daily progress notes, after having this mail i have consult with customer care and he rudely told that if i have any issue then mail to customer care. After consult with customer care, i came to know that they have received the cancelled cheque which was send by me and only attested copies of hospital they required. But today (23/06/2013) I had new mail that i have to submit the cancelled cheque. I am really harassed by the department, i don't know the amount would me credited or not. Even the customer care also not cleared which document actually they required. So request you to, inform me which document you really need for full & final settlement. So that i can collect it once and try to send you soon.

Dear team,

As per company norms i am having your companies health insurance policy which i had taken from muthoot from gandhidham, kutch- gujarat, 370201.

I was admitted in hospital last month due to stone in my stomach,

At the time of purchasing the policy it was said that 2 premium amount of policy should be paid than claim will be passed as said by your apollo employee.

Last week i have submitted all the related docs and today when i called up to your employee he said that claim is rejected as 2 whole year should be completed.

On fridat i.E. 06/06/2014 aplollo employee said that he had mail at head office for 1 month deviation as my policy is getting expired in july month. So today when i called him up he said that head office people had rejected the claim as 1 month deviation is not allowed.


Kindly help me out from this.

The amount is not a big deal but i want that apollo health insurance policy who had taken should not get any harassment like me i am having the problems.

Apollo muniach was having tie up with muthoot as a cross sell product.
As from my reference many customers had taken policy from gandhidham, so its a request for h.O. People to consider the deviation for the same.

Kindly do the needful asap.

Waiting for the reply.

My contact number :- [protected]

My dear, My Policy Number is [protected], i have taken this policy two years back and Coverrage was 500k, this is restore policy, No claim bonus added to my policy i.e. 500k . 5 june is my renewal date and i have again paid STD Payment, Chq is debited from my account, Now still they have renewed my [policy and asking for extraloading excess payment and also exclusion added without any preinfo to me . i m really surprised to know how they can add exclusion in running Policy . can any one reply my questions : why we are taking Policy ? if policy is running and active can exclusion be added ? Can any one help me to resolve this and let me know where to complain for this Pl. send me email at [protected]@creativecadcam.com, +91 [protected]

I had applied for claim of Apollo Munich health insurance.

Kusum lata chauhan
claim number 147636
Member Id : [protected] on 26th sep'13.
Policy number 1102/11001/[protected]-02
Name of hospital:Ashwini heath care

The reason being told to me that insufficient document.

Request has been rejected because of "not submisson of original documents"
but on 26th sep i already sent all original documents evrything
precrption bills etc.. on this address

Apollo Munich Health Insurance Company Limited.
Gurgaon: Corp Office;10th Floor, Building Number 10, Tower B, DLF City
Phase 2, Cyber City, Gurgaon 122002

Then from that time period and today 7th may 2014, continusly I am
forwording the mandatory document as per their mail.and even the
copy of cancelled cheque. and now
I do not have any paper and i forwarded them all the related
documents whatever document they need.now i am tired of being sending
paper again n again, Now they are asking new paper for discrepancy and
first detection papers when patient diagnosed to have Diabetes
Mellitus & Hypertension.Everyday you demanding for a new paper weather
document are mandatory or non-mandatory, I Just wanted to tell you one
last thing that, she had diabetes and she was not taking any medicine
from the first day as per doctor concern and after finding Diabetes
Mellitus & Hypertension.and we do not have any papers which you need
now.Last year, same Apollo Munich gave a claim of 52k, That time, they
were aware about everything.now they are creating problems for claim
because of reimbursement scene and If nothing is going to happen, just
let me know.I have another ways to find out the claim.

This was my last mail for TPA, Now i and forwaring all the details and
mail to consumer court office.now i need to take an legal action
toward TPA or Apollo Munich.This is totally harassment case, Now i just
have this way to get the claim.


--


Thanks and Regards

Meena Chauhan
Email:meena.[protected]@gmail.com
Ph:+91-[protected]

I have a health insurance policy with Apollo Munich Since June 2013. On 1st December, I accidentely fell down. I rushed to MGS, Punjabi Bagh Hospital to emergency ward where I got advised for orthopadic doctor. In the meanwhile X-Ray was taken. Doctor came and found fracture in left leg ankle. He covered by left with raw plaster and said to come again after 5 days to re-plaster. I visited again and my leg cover with plaster for 2 months. I applied for claim and Apollo Munich declined it by saying it is not fracture but just alignment. However it is very clear in doctor prescription and X-Ray that it is fracture. I send email to them did not get any responses and now they stop responding to my emails. Can you help me in this ?

My agent convinced me to buy Apollo Munich Health Insurance for my younger brother, however, I faced the actual reality when I applied for claim. My younger brother suffered from high fever, so I took him to nearest hospital where he was diagnosed with dengue, later I came to know that cash less claim is not possible so I paid from my own and applied for claim. They asked for documents that I sent them, then they sent some one for verification, still they didn't processed claim. We kept on following up, then after a long time of follow up they demanded another list of documents. It seemed that they are searching the options to reject the claim. Apollo Munich is a third class insurance company, they just find ways to reject the claim. My claim ID No : 157067-1 is pending because of their wrong intentions. They have requested the documents for the third time to find ways to reject. They are big cheat. They keep on demanding more and more documents. My younger brother is a college going student, they are asking him to collect so many documents in order to reject the claim. I requested them to collect the documents themselves, but they didn't responded. I will never recommend to go for Apollo Munich Health Insurance. In fact, I request all the policy holders to support me in fighting for the justice. Shishir Gupta +91-[protected]

dear sir, i, ravi ranjan chauhan, i bought accidental pollicy on 16 jan 2014 by relationship manager Name-Shipra my policy no is [protected], i gave id proof and checqe but she didn't give me receving.she told me i will give you receving tomorrow but she didn't.i go to office for receving but shipra was not there ;then your officeboy tell me what is your problem then i told them .they says me go to that counter on that couter i go, go back that counter.they begins to bother me as peon and your peon sit like manager i said to your office boy' kya mjak h(what halies is this)then shipra call to me and then siad why are you soughting there.i surprised and confused that where i go goverment office or private.I heard that private give respect +services but here it is opposite

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:[protect...⇄ 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]...⇄ 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. Yours Sincerely, Authorized Signatory This is a computer generated letter and does not require signature. ________________________________ 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. Error! Filename not specified. 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. Error! Filename not specified. 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. Error! Filename not specified. 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. 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. 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.

Member ID: [protected] - Baby Kavya Njali Optima Restore Floater Policy Number: 110103/11121/[protected] Claim intimation Id 4th november 2013 : 159218. Claim Id : 36200. Sir/Madam, I purchased this family mediclaim policy online on the 13 aug 2013. Now when I submitted my claim they are denying to accept the "Discharge summary" issued by the hospital. The hospital says that they cannot change their format as per the different requirements of different health insurance companies. The lab report they asked I sent on 4th December 2013. Now they seem to be trying to find excuses not to settle the claim. The other policy details are written below. Kindly help me in either acheiving the settlement or exposing this high scale online fraud. Issuing Office: Policy Holder's Name: OPTIMA RESTORE POLICY SCHEDULE - Optima Restore Floater Gurgaon Sales Office Soumya Ratheesh Policy Holder's Address: Soumya Nivas Kesava Puram Vellalloor P.O. Kilimanoor Thiruvananthapuram - 695601 Kerala India Regards S Ratheesh Mob:[protected] Email id : [protected]@gmail.com