Apollo Munich Health Insurance — Not being allowed my cashless claim!

Address:

Faridabad, Haryana

Dear Sir or Madam: I had applied for a cashless claim vid your claim no. 169016 for an operation, which is crucial for me to be done, as I am diabetic since last 2-3 years. I have been denied the claim on the grounds that I am supposed to submit my first diagnostic report- i.e. when I was first diagnosed with diabetes, which I do not possess anymore as I never thought that it is a prized possession that I should keep me with me all lifelong, and it wasn’t really a happy news. I have been paying this premium since 2011 to Apollo Munich and this policy was overtaken in continuation from my previous medical insurance company. My agent’s name is Mr. Mridul Kataria and code no. is 80154682. I sought help by calling in at the call centre after I was denied the claim, and they registered by complaint/application [no. 1435859]. On enquiring about the progress of my application, I came to know that I have been denied the claim however I would be allowed to be reimbursed for the same. However I do not want a reimbursement, because this is NOT what I signed up for. What I do not understand is that I PAID for “CASHLESS” policy – and if Apollo Munich has failed to keep up with the meaning of the same, I’d like to make them understand that what is exactly a Cashless policy:- Cashless policies mean that the health insurance company settles the bill directly with healthcare provider, whether a hospital or a nursing home. This is to reduce the direct financial burden on insured individual at the time of hospitalization. Therefore, whatever bill is raised by the healthcare provider, Insurance company settles it directly through a Third Party Administrator. Advantages of insurance health cashless facility Cashless health insurance is of great advantage during medical emergencies Cashless health insurance facility reduces a customer’s financial burden and helps him recover with peace of mind. It helps customers who do not have immediate liquid money for pay for their hospitalisation expenses. [Source: MoneyControl.com] I have already paid a premium of 28, 000 INR and I do not understand how can I be told to pay for the operation and then get reimbursed later- if I wanted a service like then why would have I opted for CASHLESS policy? I do not have the money to pay for the operation and it is highly important that I get it done and on the date appointed i.e. 19th March 2015 – Thursday. I would like to avail the service that I paid for – cashless policy and I need to it be done on time. I do NOT want a reimbursement because firstly I do not have the money to pay for the operation and secondly I did not sign up for a policy that would reimburse me but a policy that allows me to avail medical care CASHLESS. Kindly look into the matter and treat it as highly urgent. Yours truly, Rajeev Aggarwal