[Resolved] Bajaj Allianz — Medical reimbursement amount not fully settled

 
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Vadodara, Vadodara District, Gujarat, India
 Krishna p Nair
Policy# OG[protected]-00000004 Claim Number#OC[protected]-00043374 ID Card# WFR-16-274A Final Diagnosis: Maternity Patient Name: SHYAMA NAIR. My Name: Krishna Prasad Nair, Mob: [protected] I Have Bajaj Allianz Family Medical Insurance which is provided from my Employer Weatherford. My Wife who is admitted in hospital for delivery on Oct-30-2015, the new born baby was premature and have low birthweight so for Doctor kept the child in ICU for 8 days, Total 10 days we spend in Hospital after we got discharge on 9th Nov 2015. Because this hospital is not in Bajaj allianz Network hospital i have to submit all discharge bills, Pharmacy bill etc for reimbursement. When i initially submitted all documents to Bajaj Allianz representative they accept all documents and forwarded to his main branch office which is in Pune. They have several remarks & comments on submitted bills. However i had completed all required formalities as mentioned by Insurance company. After so many E-mail conversation they partially settled my claim amount. Total Claim Amount: 27805 INR & settled amount was: 24813 INR, Total Amount Deducted: 2992/- INR. For 2992 INR amount they said we can't pay for plastic sheet-40 rupees, 300 Rs for Baby Diaper, 20 rupees for gloves, 12 Rs for carry bag, 50 rupees for green gown & 70 rupees for some bed sheet. Total Rs. 492. This understable and do not need it. But remaining amount i.e 2992-492= 2500 INR which was deducted against Electricity charge & Housekeeping Charge. which is mentioned in Hospital Discharge bill. The hospital have their own procedure of issuing bill that is thay make parts of total room rent bill. i.e. if 1000 rupees is room rent, they take charge 250 INR for electricity & 250 INR for Housekeeping and 500 INR for other charges. Now Insurance Company saying they can't pay for Electricity & Housekeeping Charge as they mentioned in bill. I just want say that without Electricity and Housekeeping how can any person can spend 10 days in hospital with newborn child. They saying because of wording of Electricity and Housekeeping they can't pay. Insurer Contact details: 2nd Floor, Bajaj Finserv Building, Survey No.208/B-1, Behind Weikfield IT Park, Off Nagar Road, Viman Nagar Pune-411014 Phone:[protected],[protected],[protected] Fax:[protected] Please do needful
Complaint marked as Resolved 

Complaint Status


[Jan 04, 2016] Bajaj Allianz customer support has been notified about the posted complaint.
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Bajaj Allianz Customer Care's response, Jan 05, 2016
Hi Krishna Nair, Greetings from the Bajaj Allianz GIC team! Thank you for reaching out to us with your concern. We have forwarded your policy/contact details to our team who will be reaching out to you at the earliest to understand your issue in detail and offer assistance. Do mention Reference No. ORM010501 during any follow up. Bajaj Allianz, General Insurance
Verified Support
Bajaj Allianz Customer Care's response, Jan 21, 2016
Hi Krishna, we would like to inform you that our team has sent an email to you with regard to your claim issue. For any queries you might have, do revert on the email. Bajaj Allianz, General Insurance
Complaint comments  3 Comments     Updated: Share0Tweet0

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Till Now, after 12 working days their is no Positive action taken by Bajaj Allianz Team. Just one phone call came to confirm the problem that i raised.
I had gone through the E-mail. There is no New comments in mail. same things said

"Kindly accept our sincere apology for delay in replying and inconvenience caused to you.

With a view to look into and resolve your grievance, we have once again gone through the relevant documents pertaining to your subject policy with us, and after thorough scrutiny of our official records, we would like to confirm as under.

We confirm that, as per policy conditions below Miscellaneous claims will not be payable.

Miscellaneous: Rs.675+675/- House-keeping + Rs.450+450/- electricity and water charges not payable".

Nothing changed in sentence.

I just want to a question that, How one can Spent 10 Days in Hospital Without Electricity & House-keeping?

Just give me answer.
I had gone through the E-mail. There is no New comments in mail. same things said

"Kindly accept our sincere apology for delay in replying and inconvenience caused to you.

With a view to look into and resolve your grievance, we have once again gone through the relevant documents pertaining to your subject policy with us, and after thorough scrutiny of our official records, we would like to confirm as under.

We confirm that, as per policy conditions below Miscellaneous claims will not be payable.

Miscellaneous: Rs.675+675/- House-keeping + Rs.450+450/- electricity and water charges not payable".

Nothing changed in sentence.

I just want to ask you a question that, How one can Spent 10 Days in Hospital Without Electricity & House-keeping?

Just give me answer.

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    Bajaj Allianz - Medical reimbursement amount not fully settled