Family Health Plan [FHPL] Complaints & Reviews

Dear Sir/Madam I am an HDFC BANK employee (employee id C1339), I have an health insurance with fhpl I have got admitted in FORTIS HOSPITAL NOIDA on 21/08/2014 as per doctor's advice as I was spitting blood from my mouth (as per doctor's I was suffering from hymoptysis), now your company is rejecting the claim as there was no need of hospitalization. I followed the fortis doctor's instruction if your company has any issue than you...

Hi,

I have a medical insurance cover from FHPL (fhpl.net) through my company. My wife went under surgery in July and was discharged from the hospital on 16th of July. I submitted all the documents on 11th august. As per the company rules, all claims have to be submitted within one month of discharge. Despite doing so my claim was rejected and the reason given was "Delay Submission". After lots of follow up they said...

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 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

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 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.

Sir, we have done investigation before admitting only but simply by telling only admitted for investigations the claim has been rejected pls do needful

Hi,

I have submitted Medical Claim ID: 3460565 for my dependent . But the Claim got rejected stating the reason as "Rejected due to not submitting the mandatory document. Even after multiple follow up (more than 2 months) still I could not find out what is the mandatory document which they are expecting.

Kindly help me to sort this issue.

Fhpl taking 10 to 15 days to update in custmer portal. Why it's happening idont know. Fhpl taking toomuch time.If want good relation all brokers don't business to fhpl

Hi,
My documents received on 23/10/2021
Still not received credit it takes how much time for credit process. Please clarify...
Employee id-S34521
Claim ref.no-3529453

We are trying to raise a claim and calling the mobile numbers provided on the ID cards, both the numbers are not responding. Called Toll free, they said they can't respond by phone to my question and asked me to send out an email. I have sent an email and then follow ups but no one answered yet.

This type of service in Insurance sector is not at all expected. I definitely will not go with any insurer whose TPA is FHPL.

I had submitted all the required bills to process the disallowed amounts against my claim # 3350581 on 04-Aug-2021. Till today i have not got any response from any one. The Grievance team is not helpful even after writing to them 2 times. They just copy paste a generic template as reply.

BA NO 11203392 UB AROGYADAN. I hadsent a claim to sardar patel road address of good health tpa. Before sendinfg, I contacted Family Health TPA and as they me to send the clain to Good Health as my ADMISSION TO HOSPITAL WAS 06/06/21. Now THEY HAVE SENT ME A MAIL TO ME STATING THAT I BELONG TO FAMILY HEALTH, BUT THEY HAVE NOT RETURNED THE ORIGINAL DOCUMENTS.

PLEASE ADVISE ME WHAT I SHOULD DO
REGARDS
RAJENDRAN