[Resolved]  Reliance Healthwise Policy — Delay in medical reimbursment

healthwise — claim not yet received

Dera Sir,
I have taken a reliance healthwise policy from your company The policy no is[protected] which was issued on 1 August 2007.I had to undergo a surgery in the month of march 2008.After i was recovered fully i have submitted all the documents related to the claim but till today i have not recived my claim amount.I had informed your TPD about the same on the first itself when i was admitted.Despite of taking follow ups from reliance i have not yet recived any satisfactory answer from your side.
Now finally i have taken a decision to go into consumer forum or Insurance Ombudsman.

Reliance General Insurance/ Medical policy — Medical Claim not Received

Reliance General Insurance (RGI) received money against medical policy (24/05/2009) (Me (DILIP SINGH RATHORE) & my Wife (SWATI RATHORE), after some time my wife hospitalised, i take all process as required (Booked complain, submit medical bill, test report doctor's report) but still not received any claim from Reliance General Insurance. also his TPA not responding properly say your claim is going for final opinion (final opinion cross more than 2 month)

NAME- DILIP SINGH RATHORE
Mob: [protected]
Policy no:[protected]
Claim No: 4206813

Healthwise Policy — delay in issuance of receipt

me and mywife are policy holders for las two years under policy no[protected] and2 [protected] this year renewal of my policies was done on 27 /11/2009 the agents/workers of your orginization in jammu deayed issuance of receipt in my favour saying that you provide us your bank details for the previous year .beacause of my busy schedules i was not in position to give them all bank details .i as horrased by them.baleing a custumer of this company .why they are askingafter renewa. i have lost my faith.

Respected sir, Date : 14.07.2010

Sub : Complaint against claim – TPA Medi Assist
playing game -Reg

My present ailment is not a pre-existing one and not a heredity

Dear sir,
I K. Srinivas working in JMC Projects (I) Ltd, was attacked by heart related breathing problem on 30.01.2010. At that time I was working in Chennai and immediately I was admitted in nearby Chettinad hospital and after primary treatment there they referred me to Dr. Narasimhan who is working in CARE hospitals Hyderabad and he is the top most person in India for my problem. I was undergone by several tests by Dr. Narasimhan and finally on 10.02.2010 he said that surgery is the one & ultimate solution for my case. He also suggested to go for surgery at the earliest. The surgery costs around 6.00 Lakhs as per hospital sources. Through my office I am having insurance for 1.00 Lakh only which I have not gone for it. Secondly I thought of my personnel health insurance ( Policy No : 1304/[protected] which I have taken in the month of July 2008 . It is Reliance General Insurance ( Health wise policy ). Unfortunately my name was considered as Srinivas . U.K instead of Srinivas.K . Around 15th of February ' 2010 I gave an application in the Electronic city, Banglore Reliance Insurance office for changing of my name. Against my name changing I got confirmation in one week. I went to CARE Banjara hills, Hyderabad for surgery on 22.02.10 and admitted on 25.02.10 and got operated on 25.02.10 by them.
I have taken the policy in the month of July 2008 and its TPA is Medi Assist (I) Pvt. Ltd, Bang lore. Before my admission on24.02.10 I gave written application to avail the cashless facility through Hospital Insurance people but there is no response from TPA and I was discharged on 27.02.10 by paying the fee interms of cash by borrowing the huge amount from friends and relatives ( Rs.539265/-). My officer in Bang lore transferred me to Hyderabad keeping my ailment in view. I applied for medical reimbursement with all required original documents in Medi Assist office in Bang lore and against that I received acknowledgement also. All this happened in the month of March 2010. Later I shifted my family to Hyderabad and Joined in Hyderabad office on 18.03.2010. When I gave my claim application in Medi Assist office in Bang lore they said that if no reply comes before 15 days they gave a landline number to call back. I got my complaint number as 4839263 on 20.03.2010 noon. One month after applied, I called the Toll free number stating my complaint number, they replied me that it is under process as there is no response from given number ( Land Line ). Around 20.05.10 I once again called for my claim & I got reply as it is under process. For further enquires I got the numbers of Delhi office stating as the claim belongs to huge amount. From then I am calling Delhi office but the concerned person is not responding. Other persons are attending and replying that I am not the concerned but I will forward and but nothing was done. At last I contacted Dr. Jyothi of Delhi on 07.06.2010 and she said that the important original documents are not given so kindly produce those documents to close the issue at the earliest. The queries they have are :
1. Provide all original prenumbered payment receipts against final bill
2. Provide all past treatment papers regarding present complaints
3. Provide all past policy copy details
4. Provide certificate from treating doctor for confirm exact past history and cause of present ailment and provide first consultation papers when present ailment diagnosed for the first time.
5. Provide all investigation reports done during hospitalization regarding present complaint
6. Provide original hospital final bill
7. Provide CAG report
8. Provide sticker / invoice of implant
With out the above details is it possible to process the complaint ?
That means they simply killed valuable time and they purposefully does not want to reimburse the amount . It is useful for their excuse if I proceed legally, that we didn’t said we will not do reimbursement provided all original documents are fulfilled as per the requirement. It is simply to escape. If they really don’t want to reimburse they can go for specific cause after thorough enquiry. (1) . If I say with hospital that I need another set of my original bills from each and every hospital from the beginning of present ailment they will suspect me and they will not give. (2) . If I start procuring the said documents it will take a minimum of 3 to 4 months at least as I have to collect from different places.
My present ailment is not a pre-existing one and not a heridity
In between around 24.05.10 when I spoke with Delhi office they said that as the case is pertaining to Hyderabad the file is transferred to Hyderabad and immediately I contacted Hyderabad office they said that they have not received any such file . (I quoted my claim no. for reference.) To Bang lore office along with all requisite original documents for claim I submitted the Xerox copy my name change also. On 08.06.10 when I asked the Delhi office about the queries that I have submitted in Bang lore office they replied that in respect of Bang lore documents speak with them only and ask them to update them so that it will be updated in our system also. Since then I am trying to contact them but there is no response from Bang lore office. I request you to kindly do me the needful in this respect.
Conclusions of the case :
1 ) With out going through the documents I have submitted against claim they time passed by saying it is under process.
2 ) Not responding to phone calls
3 ) Giving wrong information that the case was transferred from Banglore to Delhi and Delhi to Hyderabad
If the TPA wants to make enquiry they can make but at the earliest as already time is being wasted by them.
Thanking you sir,
K. Srinivas Yours truly,
19-44/2, Flat no: 002,
Meghana Enclave,
Gowtham Nagar, K . Srinivas
Malkajgiri,
Hyderabad – 47
Mobile: [protected] : [protected]