Family Health Plan [FHPL] Complaints & Reviews

I was admitted in hospital on 22.05.2023 for hip replacement surgery and released on 27.05.2023.
As per insurance clause I have send hard copy of all original documents through courier on 26.09.2023 and acknowledge by TPA(FHPL) on 28.09.2023.
First they have rejected all by documents, later I understand that they entered wrong input.
After several mail communication they apologize their mistake, and correct the entry,...

Claim ID - [protected]
UHID No - NIC44463350

I admitted in a hospital for deivery with cashless insurance which covers 80% of my hospital bills. I have a secondary insurance to which I have to provide all the details and claim the remaining bill. For that purpose they wanted few details from the primary insurance company.

I sent first request mail on Dec 17, 2023 and have sent more than 10 reminders after...

I have claimed reimbursement of my spouse for the treatment of "RE;MICS+IOL UNDER GVP UNDER MONITORING DONE" amounting to rs. 46732/-. After submitting all the relevant documents, query by the health insurance company for submission of cancel cheque for reimbursement. After submission of cancel cheque, health insurance company has rejected my claim by mentioning reason "Valid claim [protected]-1 generated under top up, Hence claim is rejected"br...

The hospital has provided necessary documents for approval but the fhpl insurance company is not responding, and the customer care pple are also not replying properly. V hv been waiting at the hospital for claim since 12 noon and till now they've not approved it. Fhpl is the worst insurance company. The preauth person of banglore has switched off his phn. Is this the way u treat...

I have submitted claim for hospitalization due to viral infection on 8th March 2023 with claim id [protected].
However, the claim is settled 5, 000 only, with reason “it is considered as pre-maternity treatment and only 5, 000 allowed for that category”.

But I was submitted the claim for viral infection only, not for any kind of maternity treatment.
• Also I informed claim intimation as “admitted for viral infection”, at the day for hospitalization through toll-free number.
• And, in the claim form also I ticked “illness” only, never ticked “maternity” check box (attached claim form).

For the only reason patient is pregnant (5 months) while treating for viral infection, seems this claim converted in to pre maternity treatment. This is un-expected.

Could you please re-investigate / verify / process the documents and claim form I have provided and approve the balance amount also.

If any other details needed, please let me know.

I have contacted "[protected]@fhpl.net" and "[protected]@fhpl.net" also, but no success.

Explain why my mails from monto.[protected]@aiesl.in to [protected]@fhpl.net is unanswered

This claim is knowingly delayed or rejected by Manas Roy. All the Required documents has been provided to the TPA FHPL. Details are attached below. Kindly reimburse the bill.

Hospital Name : Others OPD Insurer Name : National Insurance Co. Ltd
Policy Holder Name : Kumar Pardeep Proposer Name :
Insured Name : Ritu Policy No :[protected]
Employee ID :162524 Relationship : Spouse
Claim ID : [protected] UHID No : NIC46667772
Date of Admission : 11/12/2022 12:00:00 AM Date of Discharge : 11/12/2022 12:00:59 AM
Claim Type : Reimbursement Claim Amount : Rs. 26835.00/-
Policy Period : 10/1/2022 12:00:00 AM TO 9/30/2023 12:00:00 AM CorporateName :Bank of Baroda - Employees

I have been running pillar to post for my claim of 58k for admission in hospital for severe back pain and spasm in stomach
I had the first attack on 25th Oct and consulted Doctor, was advised injection which I took from local hospital nearby. I kept taking the injections regularly for 2 day and was getting better
28th Oct morning I yet again got the same attack and on Doctor advise asked to get admitted immediately. The pain was excruciating going to both legs, lower abdomen and whole back
Since Ecard was not provided by FHPL I could not take cash less facility at hospital and paid with personal credit card.
Treatment started immediately in hospital and was administered intravenous injection through Saline.
all tests were conducted and when I was feeling bit better, was discharged and asked to follow up regularly with Doctor
I submitted all the hospital original bills to FHPL for cashless reimbursement as per policy
Later I was told the claim is rejected as this did not require admission
will FHPL or insurance company decide if patient requires admission or the Doctor?

Very unprofessional approach, confirming through video call having chat with patient and checking patient id band and medicine stock at the time of discharge. Breaching patient privacy. Company is not paying and settling the pre-post hospitalisation bill. The details of corporate employee policy no. policy no. [protected]-02 and unsettled claims are mention below along of bills claim id.

1. CLAIM (ONE) for Pre & Post Hospitalisation...

Very unprofessional and worst service, misleading and fraud. the cost and treatment was clearly mention in the pre-auth letter and we got the approval for the total cost, however at the time of final settlement they only paid half of it stating that there is a cap limit for this particular treatment. If this is true then why didnt they mentioned this clearly in the pre-auth email. when I spoke to the FHPL spoc, (Shilpa HS - Email: shilpa.[protected]@fhp.net Ph: +[protected], she was very unprofessional and went to denial mode and didnot provided any contact detail to raise a complaint.
PLEASE DO NOT ASSOCIATE WITH THIS INSURANCE. NOT RECOMMENDED

For reimbursement support i have called multiple time on their otll free number but it is showing always as busy what to do...

From:
Lucy Shyamsundar
BA no 19968
BRANCH CODE 15021
policy no:[protected]P[protected]

Dear Sir,
Kindly do not renew my insurance policy mentioned above.
In spite of writing a letter to the bank manager Union Bank of India, Vellore not to debit the premium amount of Rs.13865, the same was debited on 21.06.2022.
Kindly return the premium amount of Rs.13865 to my bank account [protected], as I do not wish to continue the policy. The bank Manager has also written to you to return the money.

I want to have cataract surgery done for my father. We contacted ASG eye hospital in Jaipur which is one of the network hospital. We were told at TPA desk there that they do not entertain cashless as New India assurance is a government company and they entertain cashless for private insurance companies only as there are some issues/talks going on with government insurance companies. I have also applied for cashless pre authorization on FHPL...

I would like to express my disappointment with the unsatisfactory
level of service.
I submitted a claim on August 16, 2021, but to this date, I have not
received my claim amount. I have submitted all the medical documents
twice and escalated them several times to the Grievance cell at
[protected]@fhpl.net and Shivakumar M, Sanjay Kumar Srivastava, [protected]@fhpl.com, claims, Rakesh Kumar, Lavanya M, Ramalinga,...

I applied for cashless, got approval started treatment and after bill they rejected with a reason "due to need of hospitalization not established", why they haven't mentioned for initial approval, if they would have mentioned in initial approval, I would have went to some other known hospital

Here I, Mr Uday Digambar Bajare (Claim id 3670429 TPA FHPL) bring to your notice that in the Month of January 2022, i fell ill as because my mother expired on 29th December 2022, then we had to follow all post death rituals in freezing cold of January
Hence due to all I was suffering Viral Fever with Acute Bronchitis (chest infection) So i got admitted in OASIS MULTISPECIALITY HOSPITAL PIMPLE SAUDAGAR PUNE which very near to my home almost 500mtrs ahead. Where Doctors did every required investigations & I received all the relevant treatment.
As after completing course of Antibiotics, l fully recovered & took Discharge.
I made all the payment in Cash & Hospital gave me proper valid receipts for same.
Then after I submitted all my claim Documents to FHPL TPA for reimbursement process & kept following for same.
In between l received mail that your claim is under verification as Hospital is black listed
After few days again I received mail that my claim has been rejected because they noticed hospital doing Malpractice.
However when i enquired for same with Hospital authority then i came to know that Few months back
excecitives from FHPL were very arrogant with their female staffs at reception & Doctors
They also provided wrong investigation report to FHPL TPA so that the claims for reimbursement will get rejected.
Even for same when hospital received that wrong investigation report, lodged police complaint at Sangavi Police Station Pune
Even As per my knowledge as my claim is genuine & all Documents are Authentic then even though Hospital might blacklisted for CASHLESS Facility then also I have right to reimburse all my expenses which I have paid for medical facilities.
Thanking you.
Mr Uday D. Bajare
Claim no 3670429( FHPL TPA)
The New India Assurance Company Ltd.

Have taken a family policy from office. which shows cashless claims. 10 days before my father in law was diagnosed with liver cancer and was admitted to the hospital.
we have used my brother-in-law insurance for the treatments. As he admitted my father-in-law as we where out of town. As he got diagnosed he was under treatment.
He was unwell again so we admitted him to the hospital again for the treatment as he had a lump growing on his back. due to the ongoing treatment for cancer.. they cannot put him on more treatment .
while he was at the hospital they investigate and found out that the lump growing is also a cancer as the hospital dint had pet scan and as he was already on medication for liver cancer and as they was improvement we discharged him as he was getting mentally ill and doctor advised as the liver cancer was more serious at the given time .
As he is already on treatment mutiple medication can worsen his health . so we discharged him and claimed for cashless.
fhpl rejected the claim stating its an investigation and the treatment has not been started.
we informed the same to the doctor who is an oncology specialist along with multiple other doctors who where overseeing his case. They told the claim rejection is preposterous as we had 4 to 5 doctors treating him.
So our doctor spoke to the insurance agent and the doctor who rejected the claim.
Who supposedly is bds doctor rejecting claims for an oncology patient telling that if he not treated. we cannot accept the claim in cashless.
Even after the doctor explaining due to complications and the existing treatment. This happened on the one of their network hospital.

FPHL is a peace of [censored]. Especially the Call CENTER employees including the Supervisor (Irfan or Imran I don't recollect the name). A CUSTOMER reaches out to company HELPLINE with an intention of getting the problem resolved but here it is vice-versa. The Call CENTER executive doesn't hold any information and always ask CUSTOMER to wait for 2working days, which doesn't end anytime. I had conversation with Multiple people in call CENTER including the supervisor and almost everyone promised to call back with an update but that day did not come yet. Surprisingly the supervisor also follows the same rule of promising your CUSTOMER for call back and sitting back holding a cup of tea and watching the show. I don't understand what is the use of having HELPLINE number as they cannot resolve neither possess the correct information. Now this is a serious concern to look in.

I am done with FHPL and there blaming game. It sucks like hell and My personal advice to everyone is not to go with this ### insurance company.
They almost took 2 and half month just to enroll my name into there system and It is almost 2 and Half month post the enrollment and I am still waiting for the claim amount.

I am not sure how long to I need to wait. I will wait for couple of days and going to lodge a complaint in consumer court.

Very Bad Experience with FHPL and there claim process.

Hi,
I am Mohammed Muntazim working under CYIENT PVT LTD. My employee id mm56880 . I claimed a reimbursement of my baby's operation but the status of complaint has not changed from more than a month.. I am tired of calling them for status update.
Please help me on this.

ClaimNo 3651133/1

Hello,

I am Krishna Putta, My wife underwent a surgery and later I have submitted all original required supporting documents/reports to claim the procedure expense. After submitting all the originals, Viman nagar Pune FHPL team reviewed and they set the status IR pending, again they are asking the original documents/reports. FHPL intent is to reject the claim but I never give up till I succeed...