[Resolved]  Family Health Plan (Tpa) Limited — Mediclaim Rejected

Address:

Ahmedabad, Gujarat

Sir,

1. Claim ID: 115812/1
2. UHID NO: 82161
3. Patient Name: Pallav Choksey
4. Claim Date: 23 Apr 2011
5. Hospital Name: Shalby Hospitals, Ahmedabad, Gujarat
6. Organization Name: Idea Cellular Limited, Ahmedabad, Gujarat

I, Pallav Ashvin Choksey, went for a medical check-up to Shalby Hospital with pre-permitted appointment from my office (Idea Cellular Ltd, Ahmedabad, Gujarat).

My report was done on[protected] which I collected on[protected] from Shalby Hospital, shows that my diabetes was
1. Fasting 254, Urine : Present (++++) &
2. PPBS- 425, Urine : Present (++++).

I was been advised to get admitted for uncontrollable diabetes. I got admitted in Shalby hospital on 15.04.2011 under the supervision of Dr. Falguni Iyer and was on Insulin as well as oral dosage for diabetes control.

My claim got rejected with the reason that my diabetes was showing 4+ as per the report on 09.04.2011 and I got admitted on 15.04.2011.


Now can you tell me that without any treatment can the diabetes get lower within 5 days automatically that my claim got rejected with that reason? No one had advised me - Neither your mediclaim agent nor the doctor of your tie-up hospital that if I want to get admitted then within how many days I should take the action? Does Insurance Company want the patient to dream for such terms and conditions.


The other reason given to me was that in 4+ diabetes Oral dosage could have worked and that I was been advised wrongly to get admitted. Can I know that the hospitals which you have selected has such doctors who given wrong advices or if the advice is right than treatment given is wrong or if advice and treatment is right then should patient get admitted himself at his own home and should take insulin on his own and get the reports on his own, which a hospital does? This is what your insurance company doctors think or say?

Even after giving proper justification from the doctor in written thrice who has treated me, your doctors are not convinced to pass the claim because they see my case to reject only. Your doctor has neither called up Shalby doctor who has treated me and tried to understand the exact situation under which I was been admitted, so on what basis my claim was rejected.

I need a positive resolution from FHPL to restrict myself to knock the doors of consumer court to present them the dadagiri of insurance companies. My claim has all the valid reasons to get admitted and then to pass the claim.

Regards
Pallav Ashvin Choksey

Address of Family Health Plan (TPA) Limited
104, Sahajanand Complex, B/h. Bhagwati Chambers
Navarangpura, Ahmedabad - 380009
http:.//www.fhpl.net
Contact No: [protected],[protected]