Heritage Health Insurance Tpa Complaints & Reviews

I am writing in reference to my claim with Heritage Health Insurance TPA with claim number HH[protected]Gururaj Vaidya) & HH[protected]Chandrika Vaidya) and my numerous follow-up emails after initiating the claim. To summarize the matter, both the aforementioned claims were intimated at the same time, the claim forms were filled in mentioning all the required data and all original supporting documents were sent in the same envelope to the local heritage health insurance office in Hyderabad via speed post. Post sending the documents claim number HH[protected] was settled (after around 3 months) but claim number HH[protected] has been kept pending.

After numerous follow-ups regarding the same, I was told that some of the supporting docs were missing and I needed to submit more documents. What I fail to understand is if the documents submitted were insufficient then how is it that one of the claims was approved, as similar documents were submitted in both cases. Upon further follow-up, I was asked to resend the original documents which again is not sensible and would not be possible as all the originals were already submitted and hospitals do not give multiple copies of originals.

Further, scanned copies of all the supporting documents and the claim form were sent via email but to no avail. It has now been 7 months since the claims were registered and I am still having to follow up and write an email and talk to various people from the organization to get the matter resolved.

As a last resort, I even sent them an email about approaching the Ombudsman and the grievance cell but to no avail. In the last 7 months, I have sent them numerous emails and have called their offices n number of times but no one bothers to reply.

Being a retired and elderly person I have no energy left in me to keep following up with these people and request the consumer forum to kindly help me in my case.

Dear sir/ madam,

My father in law was hospitalized in september - october 2018 in lucknow and then in gurgaon. He had a health insurance of 4 lakhs (3 lakhs basic + 1 lakh topup) through his employing bank, allahabad bank with heritage health tpa. Post his discharge, i submitted the claims to heritage health tpa through allahabad bank.

Post this, i received a query letters (Reference no. Hh[protected] and hh[protected] asking for further documents. After speaking with the customer service, i submitted the pending claim documents in original to their bombay office by courier (Courier receipt with counter sign available). Also, a soft copy of the original documents was sent to them over email (Attached below). However, we just keep receiving the same query letters again and again. I have replied many times to the queries but no response.

Finally i wrote a complaint to the grievance officer at heritage health tpa (Reproduced below) on 17th october, to which i have received a grievance ref no : hhs. Sompo. W.884230

I am attaching a soft copy of the documents as required by heritage health tpa claim no. Hh[protected]Claim amt: rs. 102, 515)
1. Justification letter
2. Admission prescription in original
3. Copy of aadhaar and pan card

Claim no. Hh[protected]Claim amt: rs. 66, 082)
1. Justification letter
2. Cag report in original
3. Copy of aadhaar and pan card details:

Grievance ref no : hhs. Sompo. W.884230
Name : farukh alam
Emailid : say. [protected]@gmail.com
Employee id : 11025
Insurer : sompo
Policy number : [protected]p[protected]
Card no : hhs8.[protected]
Claim no : hh[protected] / [protected]c[protected]
Contact no : [protected]

Request your help in getting the insurance company to settle the claim. Please do let me know in case you need any further information.

Sincerely,
Aleem sayed