[Resolved]  Bajaj Allianz — Mediclaim rejected by bajaj allianz

Address:Chandrapur, Maharashtra, 442908

Dear sir,
My new claim month of july 2016 not pay till date, helth insurance bajaj allianz not release my medi claim, 1) claim no. Gmc - [protected]-2002078c 2) claim no. Gmc - [protected]-2002078a

This refers to the above claims, our mr. Jaishankar singh, has received sms and mail stating that these claims are inadmissible. Also while contacted to insrance official/ customer care officer he has informed that dr. Siremdra pd, b. Sc, mbbs (Am) is not qualified doctor as per your norms. Where as in 2015 my daughter had taken treatment from same hospital / same doctor too vide claim no. Oc[protected]-00003348 dtd. 04.06.2015 all ready pay but this time bajajallianz not pay.

Sir,

What patient authority verified doctor's certificate. Not a my fault mediclaim released bajaj allianz last 2015 than my family treatment same hospital /doctor., 2016. My claim amount rs.26349.00 + rs 13275.00. Sir, all ready i pay amount of the july 2106, sir i mentally disturbed and crises of the money due to bajajallianz not pay.
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Nov 23, 2016
Complaint marked as Resolved 
Dear sir, No any response by bajaj allianz.,
Bajaj Allianz customer support has been notified about the posted complaint.
Verified Support
Oct 28, 2016
Bajaj Allianz Customer Care's response
Hi Jaishankar,

We're sorry to hear this. Allow us to get this checked with our team and we'll get in touch with you to help you with your concern soon. Also it will be helpful if you could share your contact number with us at help.[protected]@bajajallianz.co.in so that we connect with you faster.

Please note that we have registered your complaint with Reference No. BA - 1091. Do mention this Reference no. in the subject line of the mail while sending your details. Thank you.

Regards,
Bajaj Allianz General Insurance
Nov 09, 2016
Updated by jai shankar singh
Dear Mr. Singh,

This is with reference to your request in IRDAI Token no.[protected] regarding claim details, your issue no. 64381129.

We wish to inform you that as below :

Your claim no. OC[protected]-[protected] GMC-[protected]-2002078C) and OC[protected]-[protected] GMC-[protected]-2002078A) has been repudiate due below reasons:

1. OC[protected]-[protected] GMC-[protected]-2002078C) : Verification of claim documents reveals aforesaid claimant was hospitalized for treatment of Acute Pain Abdomen under care of Dr.Dr. Surendra Prasad . On scrutiny f the claim it has been verified that the treating doctor's qualification is MBBS(A.M- alternative medicine ).Also his registration number is not found in MCI register and any state medical council register.

2. OC[protected]-[protected] GMC-[protected]-2002078A) : Verification of claim documents reveals aforesaid claimant was hospitalized for treatment of Pain in Lower Abdomen with Bleeding Per Vaginum under care of Dr. Surendra Prasad who does not hold a recognized qualification. We regret to inform you the claim stands repudiated as the policy does not extend benefit for any hospitalization undergone for treatment on advice a doctor not holding a valid and subsisting license, granted by the appropriate licensing authority, and not acting within the scope of his license.

Said issue has been resolved from our end hence we are closing IRDAI Token no.[protected] from our end.

Dear Sir,
Your reply is not fair,

Per Vaginum under care of Dr. Surendra Prasad who does not hold a recognized qualification. We regret to inform you the claim stands repudiated as the policy does not extend benefit for any hospitalization undergone for treatment on advice a doctor not holding a valid and subsisting license, granted by the appropriate licensing authority 2016,

Respected Sir,

Your reply is not fair( i lost approx. Rs. 40, 000), Sir i claim same hospital and same doctor 2015 release all amounts bajaj allianz .your internal quality team was sleeping 2015.your team not warned me 2015 this doctor registration number is not found in MCI register.you not treatment this hospitals and Doctors in the further bajaj allianz not pay your claim. that was your responsibility, not a patient. Not a my fault please release my amount and next time i not taken & my family treatment same hospital /doctor. Sir i mentally disturbed and crises of the money.


regards
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