[Resolved]  Medsave — less approval of amount

Address:

North Delhi, Delhi

To
Medsave Healthcare (TPA) Ltd.
F-701 A ,Lado Sarai,
Behind Golf Course,
New Delhi-110030

Sub:- Regarding Claim in r/o Leela Devi ,Card No.-[protected]G

Sir,
I, Rohtash Kumar am a Primary Card holder and son of Leela Devi .My mother was admitted to Saroj Hospital and Heart Institute,Madhuban Chowk,Rohini,Delhi-110085 on 5/5/2010 . I called your TPA and asked if there is any package deal or any capping for the insurance we have with you. I received a reply that You will get approval without capping.I have admitted my mother by paying Rs. 10,000/- to the hospital (which is a hospital policy).They promised to refund the same when approval would come.
Now my mother was a patient of COPD And High B.P. for the last 2 years and she was suffering from Hernia for the last 1 year.My mother age is around 65 years +.So there was need to consult and take NOC for operation from Chest specialist and Cardiologist.So Doctors advised some investigating procedure like P.F.T.,STRESS ECHO ,CECT ABDOMEN,CHEST X-RAY AND OTHER tests which are necessary for the safer side of patient.
On 6/5/2010 operation was decided on 4P.M.And Hospital billing staff has contacted me and demanded Rs. 50,000/- to be deposited as a hospital policy.By that time only Rs. 36,000/- has been approved by TPA Medsave.
They told me that they have a package deal with Medsave for HERNIA case only Rs. 36,000/-.They have emotionally blackmailed me.But I have only Rs. 10,000/- that time.I have to deposit this amount so that operation procedure could be started as my mother was on NPO (without food) for 20 hours (i.e. Tuesday night-4/5/2010).
Again approval of only Rs. 10,000/- has been received by the hospital.And Medsave has told the total amount will be approved only after the discharge summary would be sent.
Now on 11/5/2010 When Dr. has given discharge permission then only Rs. 21097/- has been approved by you.
But the total bill was of Rs.84,467/- and Rs. 17,370/- has been charged by me by the hospital.Also on verbally asking the detailed story of the diagnostic tests done by Dr. Adhish from Jyoti,billing manager.A detailed story has been sent by fax by Dr. akash jain giving details about why CECT,PFT,Stess Echo has been done .
Now I request you to grant me approval of Rs. 17,370/- so that I can get refund from the hospital or in turn get cheque in my name of the amount Rs. 17,370/- which hospital has taken from me.
Kindly give me reply of this communication as soon as possible with cheque to me on
Rohtash Kumar
Mobile No----[protected]
Address----B-196/2,Derawala Nagar,Opp. Model Town-ii,Delhi-110009
Email [protected]@sify.com