Cigna TTK Health Insurance — Cashless and reimbursement request not honoured

Address:Bangalore, Karnataka, 560032
Website:www.cignattkinsurance.in

I have an active cigna ttk prohealth protect policy (prohlt[protected] for family. on aug 09, 2016, my wife got admitted to jp hospital in mohali, punjab with complain of viral fever with age for med mngt with iv ab + iv antipyretics +ppi. as usual, we have raised cashless treatment request to cigna ttk though the hospital and on aug 10, we got the approval with claim number blr-0816-pa-0001559.
Now on aug 13, 2016, during payment settlement, cignattk dishonour the claim by stating, as per discharge diagnosis, pt has hiatus hernia and according to policy terms, it would be consider before completion of 24 months of policy. yes my policy is not yet crossed the 24 months locking period.
But it is also cleared that she hadn’t received any treatment for the hernia, she been treated only form viral fever and gastritis infection. during hospitalisation, they must done all the diagnosis and in usg it shows a little hernia. but again the treatment wasn’t given for that as doctor said it’s nothing, ignorable.
When i raised these points to cigna ttk customer care, they suggested me on aug 14 to submit all the documents and bills to their claim office at m/s vidal health tpa pvt. ltd., sjr ipark, 1st floor, tower 2, epip zone, opposite sathya sai hospital, whitefield, bangalore – 560066, karnataka. to claim the reimbursement the amount that we paid towards hospitalisation after decline the cash claim. claimed amount: inr 28655/-.
As said, i have collected the required documents as per cigna ttk customer care’s advice and couriered to them and same has been received on aug 20, 2016, as per courier tracker.
Note: here with all required documents, i have submitted the doctor’s concern in his letterhead, declaring that the patient not been treated for hernia at any point of time during hospitalisation, to avoid any confusion.
I got the confirmation from cigna ttk on aug 24, 2016 with new claim number blr-0816-cl-0007419. but this time also they have raise same issue (pt has hiatus hernia) and declined my claim. they are not in position to understand what the treatment was and simply put their client in harassment. do i really made mistake to opt this policy?
I here by claim my reimbursement of inr 28655/- from cigna ttk.
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Cigna TTK Health Insurance customer support has been notified about the posted complaint.
Aug 24, 2016
Updated by Rudra Misra
I have an active Cigna TTK ProHealth Protect policy(PROHLT[protected] for family. On Aug 09, 2016, my wife got admitted to JP Hospital in Mohali, Punjab with complain of VIRAL FEVER WITH AGE FOR MED MNGT WITH IV AB + IV ANTIPYRETICS +PPI. As usual, we have raised cashless treatment request to Cigna TTK though the hospital and on Aug 10, we got the approval with claim number BLR-0816-PA-0001559.
Now on Aug 13, 2016, during payment settlement, CignaTTK dishonour the claim by stating, AS PER DISCHARGE DIAGNOSIS, PT HAS HIATUS HERNIA and according to policy terms, it wouldn't be consider before completion of 24 months of policy. Yes my policy is not yet crossed the 24 months locking period.
But it is also cleared that she hadn’t received any treatment for the hernia, she been treated only form viral fever and gastritis infection. During hospitalisation, they must done all the diagnosis and in USG it shows a little hernia. But again the treatment wasn’t given for that as doctor said it’s nothing, ignorable.
When I raised these points to Cigna TTK customer care, they suggested me on Aug 14 to submit all the documents and bills to their claim office at M/s Vidal Health TPA Pvt. Ltd., SJR iPark, 1st Floor, Tower 2, EPIP Zone, Opposite Sathya Sai Hospital, Whitefield, Bangalore – 560066, Karnataka. to claim the reimbursement the amount that we paid towards hospitalisation after decline the cash claim. Claimed Amount: INR 28655/-.
As said, I have collected the required documents as per Cigna TTK customer care’s advice and couriered to them and same has been received on Aug 20, 2016, as per courier tracker.
Note: Here with all required documents, I have submitted the doctor’s concern in his letterhead, declaring that the patient not been treated for hernia at any point of time during hospitalisation, To avoid any confusion.
I got the confirmation from Cigna TTK on Aug 24, 2016 with new claim number BLR-0816-CL-0007419. But this time also they have raise same issue (PT HAS HIATUS HERNIA) and declined my claim. They are not in position to understand what the treatment was and simply put their client in harassment. Do I really made mistake to opt this policy?
I here by claim my reimbursement of INR 28655/- from Cigna TTK.
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