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[Resolved]  CASHLESS HEALTH INSURANCE — UNJUSTIFIED DELAY IN APPROVAL

This has reference to the health policy no. 332201/48/2009/1089/332201-CBO/ Ranc of Oriental Insurance Company Limited with Cashless facility vide TPA Heritage Health Services Private Limited vide Card No. HHS3.[protected]. I wish to inform you that I am to undergo the laparoscopic surgery of solitary gall bladder stone at Dr. Ruban Memorial Hospital, Patna, hereinafter called ‘the hospital’. Please note that I have been and am suffering from acute stomach ache for the last few weeks. I have already contacted the hospital on 26th day of October 2009 and they fixed 28th day of October 2009 as the scheduled operation date. The hospital also contacted TPA (Mr. Suman Chatterjee) and informed TPA about the probable operation date and the criticality of the patient. Please note that Mr. Chatterjee also talked to me, who transferred the call to Cashless Section to Mr. Nirmal Banerjee. I have been in continuous contact with him from 27th October 2009 onwards.

I want to inform TPA that due to inordinate and unjustified/ unexplained delay from TPA’s side, I am suffering both physically as well as mentally. Not only that I have also been suffering financially due to the persisted problem. Although the policy is scheduled to expire on 24th November 2009, but the inordinate and unjustified delay from TPA’s side will have far reaching repercussion on my claim.

This is worth to note in the matter that the Oriental Insurance has already faxed the required form and then again mailed the same to TPA. Mr. Nawal, at TPA’s office in Kolkata confirmed Oriental Insurance over telephone of having received the mail. TPA’s FAX number has been out of order for so many days as per information received from Oriental Insurance.

I therefore request you to look into the matter IMMEDIATELY and issue necessary instruction to insurance company/ TPA for issuing GO AHEAD / approval/ (Form 64VV) instruction to the hospital so that the operation may take place at the earliest thereby reducing the strain both physically, mentally and last but not the least financially.

Hope you will co-operate in the matter at the earliest and do the needful in the matter.
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Complaint marked as Resolved Aug 14, 2020
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