[Resolved]  Icici Lombard — Awful claim experience

Address:

Pune, Maharashtra

This is to inform you about the awful experience that I had to face with ICICI Lombard Insurance Co.

As stated in my email below, the total estimation of the surgery for my father Mr. Bhimrao Sidnaik in ADITYA BIRLA MEMORIAL HOSPITAL, chinch wad was Rs. 1, 16,000 and a pre authorization amount was approved for Rs. 51,000. I took an approval for the balance amount and was under the impression that everything will be taken care of. Here is the situation that I had to face at the time of approval process and claim settlement.


I provided the copy of the email below to the hospital staff in order to take further approval of the balance amount. The TPE desk staff at the hospital tried to fax the details to ICICI at 3.15 pm (24th July 2010) but the fax machine at ICICI had problems and the fax didn’t get through. The system made 30 unsuccessful attempts to fax details. Finally, the details were sent via email at 4.45 pm requesting the claim approval. I called up the toll free number and got the interaction ID and was told that we would receive the response within 2 hrs of time. I kept following up on the toll free numbers as I was aware this would not be done on time based on my prior experience. I was asked to spare another 2hrs of time every time I called up; I was not allowed to talk to any person at a higher level to escalate the issue. My father was supposed to be discharged from hospital on the same day and I informed the same at the toll free call centre. No communication was received from ICICI regarding the claim amount. The discharge desk at the hospital closes at 8.00 pm and the next day was Sunday when no discharges are done for insurance cases. I called up again (4th time) at 7.45 pm and asked if the approval was done and I was again asked to wait for another half an hour while the discharge desk closed. I had to make a payment of the difference amount of the bill (Rs. 17,445.00) out of my pocket despite o[censored]s having the approval.

I would also want to mention that this is not the first instance wherein I had to go through such pain but it also happened a couple of times before recently, first when I was admitted in the same hospital when the approval process took 4-5 hours of time as against their TAT of 2 hrs and the second instance was when the pre authorization claim was submitted for my father when no processing was done at all for 4 days and finally was done when I spoke to some manager at ICICI Lombard call centre again taking 4-5 hours of time.

This is really frustrating when we are charged premium and have to go through such pain while being in the hospital. I don’t at all regret to say that it has been really a very bad and frustrating experience with the insurance company.

Gautam