Health Insurance Tpa Complaints & Reviews

The name of this HITPA should be 0 TPA.
Now this intermediary, there job is to check the accuracy and correctness of claim.
But what these jokers actually do is after wasting a lot of time, during which either the insured needs to pay out of his/her pocket to get the procedure done or wait, look for ways to reject the claim.
But this is not where there expertise ends.
After getting the procedure done by paying from pocket, and submitting the claim later, these experts reason as to why the claim was not submitted earlier.
There never ending queries, some by email and some by posted letters (depending on there convenience, not of the customers) repeat the same questions again and again and are designed to just waste time.
This 0 TPA behaves as if they are paying the premium for the customer and the customer is raising the claim for 'free'.

Another dysfunctional part of the system!

The name of this HITPA should be 0 TPA.
Now this intermediary, there job is to check the accuracy and correctness of claim.
But what these jokers actually do is after wasting a lot of time, during which either the insured needs to pay out of his/her pocket to get the procedure done or wait, look for ways to reject the claim.
But this is not where there expertise ends.
After getting the procedure done by paying from pocket, and submitting the claim later, these experts reason as to why the claim was not submitted earlier.
There never ending queries, some by email and some by posted letters (depending on there convenience, not of the customers) repeat the same questions again and again and are designed to just waste time.
This 0 TPA behaves as if they are paying the premium for the customer and the customer is raising the claim for free.

Another disfunctional part of the system!

My Claim Number :[protected]
My Policy Number :[protected]
Policy Period : 17-01-21 to 16-01-22
Name : Anil Kumar
Phone : [protected]

This is to inform you that, I came to know that my claim has been rejected by Health Insurance TPA by saying Fraud, Misrepresentation, Concealment. Even after waiting almost 6 months of processing time and investigation they says this. I want to know what fraud and misrepresentation were done by me or the hospital. I was admitted on the same date, and done the treatment somehow managed to survive from Covid 19. I was so sick and saturation decreased drastically and with the support of oxygen and proper medication I managed to come back to normal life. We as privileged customers normally think that my mediclaim company will support me when this kind of situation comes. That was the peak time when all over India suffered from covid spread especially Delhi NCR due to lack of oxygen. Everyone knows that. It was too difficult for me to get a hospital that time, and somehow we managed to get a hospital with O2 support through one of our sources. It was all happened and the treatment has been done, and now my insurance company says we have done Fraud and misrepresentation to get money from them????? Are they serious? I want this case to be reopened and re-investigated. Also This has to be taken legally now. Hospital is also with me on this. Even after 10 years of relationship and constant renewals my insurance TPA says I am involved in fraud activity to get my genuine claim done. I cab bring each and everyone who were involved with me at the time of my treatment. For me its personal now and this is mental harassment. This is absurd and totally illogical reason given just to reject my claim. There is no use of taking such policies without trust. Kindly Help me please to get my genuine cliam... please.

All required papers were submitted by me, my agent Mr.Vimal ([protected]) knows the same. I have even visited their NIA branch as well which is in Yusuf sarai. Whenever the query was raised it was cleared by submitting the relevant documents. TPA should have informed me before rejecting or not getting support from the hospital, also it should have mentioned non cooperation from the hospital end instead of saying Fraud and misrepresentation. Who are they to decide this? This is literally an unprofessional approach from a nationalized firm.

Anyway I am taking this up legally now, I want a clear explanation from them, also would request you to reconsider the case and do the investigation properly. If you need any kind of support documents from the hospital then let me know. If there is any discrepancy found by their investigation team then they should have informed me or the hospital via Email or through any other communication method. That is the proper protocol to be followed. They have taken more than enough time to get the investigation and process. I have all the mail trials with me where I have done the follow-ups and reminders.

Look forward to hearing from you as soon as possible.

I really want the legal authority to intervene on this case and please help me to get my genuine claim processed this time.

Thanks & Regards
Anil Kumar
+91 [protected]

My Claim is not processed yet and I have provided the documents like 4 months before, one of the worst health insurance companies.

I request you to please pay the amount ASAP.