Family Health Plan [FHPL] Complaints & Reviews

Family Health Plan (TPA) Limited company rejected my claim id 924044 and 924046 with out proper reason.after so many remainders also they are unable to give reason for rejecting the claim.

i am requesting the company for proper investigation and do the needful.

We have a medicalim policy of my father... he died on 5oct2014 since then i have mailed several times to the company but no reply from them... details of policy is ---
Name of the Policy Holder : Kundan Das Butani Policy No : 112500/48/2014/1526
Name of the Insured : Kundan Das Butani Relation with Employee : Self
Corporate Name : Birla Sun Life Asset Management Co. Ltd Employee ID : ARN-18611

I have taken family mediclaim from fhpl. My claim no is 941359. I have submitted all my claim documents on 9th jan 2015, but still I haven't got my claim amount. I have been regularly following up with concern department over phone and mail. Every time they ask for furthe more time. I have checked with hospital as well and they said nothing is pending from their end.
Please look in to the matter.

Dear Sir, I Hari Kishore Mehrotra admitted for surgery on 25/10/2015 thereafter I have submitted claims to family health plan ltd after some time I came to know that some documents are require for claims on 15/12/2015 I have send all require documents though seep post EU[protected]IN on 17/12/2015 they inform me that they had not received the same since then I have send all documents on email add [protected]@fhpl.net mihirkanti.[protected]@fhpl.net [protected]@fhpl.net. they are denying that they have not received Thanks Hari Kishore Mehrotra

Hello, I Lokesh N Shah holding a policy # 355000/46/14/[protected]. I have taken the above Health insurance policy by paying 20K as a premium for sum of 2 lacs. Recently, my father was hospitalized and as Cashless treatment was denied, I had to pay whole hospital bills from my pocket. The, I did furnish all the relevant/ required- discharge summary, diagnostics report, day to day activity report to TPA for reimbursement claim on July 02. On Sept 11, 2015, I received an mail from TPA stating my claim has been denied stating Clause no. 4.10. At the time of taking the insurance, you give us 2 sweet options: - Cashless treatment - Claim reimbursement by submitting the bills/ discharge summary I am paying INR 20K/ per annum from my pocket just to insure my parent’s health. Now, almost after 70+ days, you straight away deny the claim. What does the below mean? As per our medical opinion and submitted documents, the present hospitalization is for the investigation and evaluation of the ailment only. Hence we regret to inform that your claim is repudiated.Clause no. 4.10 Did anyone from your insurance company visited the hospital in person to see the patient as to what for he is been hospitalized and is it only for investigation and evaluation of the ailment? As far as I know, any human being will be taken to hospital once he /she is suffering from some ailment/ disease/ injury and then doctor’s in hospital will do their investigation / evaluation, diagnostics and then advises the further medication. You or your FHPL team cannot expect that patient should again have scissors/ epilepsy in front of doctor’s team. Then you say it fits in your clause and approve the reimbursement.

My wife was undergone with minor surgery on Date of Admission : 22 May 2015 Date of Discharge : 23 May 2015 Received Date : 01 Jul 2015 diag treatment : Secondary infertility for Diagnostic hysterolaparoscopy with ovarian drilling. after the operating i submitted the billls from the date of consultation till the surgery complete amount is 60, 567Rs/-. now they rejected with a simple note saying this will not covered under the claim policy. before she is getting hospitalized i have informed them prior about the cause she is getting going for the surgery. Now i dont have hopes on these insurance companies when they say every thing will be covered all my 6years of exp not even once i claimed it today first time when i claim insurance it got rejected. at last am planning to go legal but i just got this some how booked here lets see if any one will look in to this matter seriously. am really in a worst situation used my CC and nothing left on me now.

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...

I have received cheque no.014593 against claim ref. ID no.530970 for Rs.25250/- for prostrate operation which is maximum permissible amount for insurance coverage of Rs.1.50lac. But my insurance is for Rs.3.00 lacs and the
maximum permissible amount for Rs.3.00 lac insurance is Rs.35500/- As such you are requested to send me the balance cheque for Rs.10, 250/- at the earliest as already a more than amonth has already passed.

Meantime, please acknowledge the complaint.

Inder Prakash Khanna
210, Dhruva Apartments,
Plot no.-4, I.P.Extension, Delhi-110092
(Retd. Allahabad Bank Employee )
Mob.No.-[protected]

Please do not trust the Apollo health insurance provided by FHPL its all fraud. I had called the customer care before addmiting my son and was informed its covered in group A category and the projected billing would be 28k based on the repersentative information i completed all the formalities and was procedinv to OT however i hot a msg the claim was rejected and the hospital ask me to pay 28k as the operation should not delay i made the payment of 17k and called the number provided by the customer care and came to know its not covered if this was the case the call center executive should have not given me wrong information.
Today i need to pay all the charges claimed by hospital.
This is pure cheating and fraud

Dear Sir

As regarding my Registar Letter dt31/08/201
Detailed Track Events for : RG[protected]IN the track record shows following:

Date Time Status at Status
31/08/2012 10:34:05 KHANPUR Article Booked
31/08/2012 21:38:38 AHMEDABAD RMS Article Bagged to KOLKATA RMS
03/09/2012 11:54:02 KOLKATA RMS Bag is Opened
03/09/2012 14:29:22 KOLKATA RMS Article Bagged to SARAT BOSE ROAD

I request to please give me the correct ;date and time of the delivery ;done after ;03/09/2012 to the address where it is sent.

Hoping to get an immediate ;reply.

Thanking you.

IQBAL

Reg Claim no:213711
I have submitted claim for amount RS 93897.00.
But I was paid amount 41619.00 rs through Axis bank Cheque no:934175.
I was told by my office that I have to pay 10% of my claiming amount and rest will be covered under fhpl.
In the letter mentioned it is mentioned that ambulance charges are not covered as per policy conditions.
please let me know why ambulance charges(47780.00) are not covered under this policy while it is a part of treatment.
Patient is moved to hospital only through ambulance in medical supervision.

Sir,

1. Claim ID: 115812/1
2. UHID NO: 82161
3. Patient Name: Pallav Choksey
4. Claim Date: 23 Apr 2011
5. Hospital Name: Shalby Hospitals, Ahmedabad, Gujarat
6. Organization Name: Idea Cellular Limited, Ahmedabad, Gujarat

I, Pallav Ashvin Choksey, went for a medical check-up to Shalby Hospital with pre-permitted appointment from my office (Idea Cellular Ltd, Ahmedabad, Gujarat).

My report was done on[protected] which I collected on[protected] from Shalby Hospital, shows that my diabetes was
1. Fasting 254, Urine : Present (++++) &
2. PPBS- 425, Urine : Present (++++).

I was been advised to get admitted for uncontrollable diabetes. I got admitted in Shalby hospital on 15.04.2011 under the supervision of Dr. Falguni Iyer and was on Insulin as well as oral dosage for diabetes control.

My claim got rejected with the reason that my diabetes was showing 4+ as per the report on 09.04.2011 and I got admitted on 15.04.2011.


Now can you tell me that without any treatment can the diabetes get lower within 5 days automatically that my claim got rejected with that reason? No one had advised me - Neither your mediclaim agent nor the doctor of your tie-up hospital that if I want to get admitted then within how many days I should take the action? Does Insurance Company want the patient to dream for such terms and conditions.


The other reason given to me was that in 4+ diabetes Oral dosage could have worked and that I was been advised wrongly to get admitted. Can I know that the hospitals which you have selected has such doctors who given wrong advices or if the advice is right than treatment given is wrong or if advice and treatment is right then should patient get admitted himself at his own home and should take insulin on his own and get the reports on his own, which a hospital does? This is what your insurance company doctors think or say?

Even after giving proper justification from the doctor in written thrice who has treated me, your doctors are not convinced to pass the claim because they see my case to reject only. Your doctor has neither called up Shalby doctor who has treated me and tried to understand the exact situation under which I was been admitted, so on what basis my claim was rejected.

I need a positive resolution from FHPL to restrict myself to knock the doors of consumer court to present them the dadagiri of insurance companies. My claim has all the valid reasons to get admitted and then to pass the claim.

Regards
Pallav Ashvin Choksey

Address of Family Health Plan (TPA) Limited
104, Sahajanand Complex, B/h. Bhagwati Chambers
Navarangpura, Ahmedabad - 380009
http:.//www.fhpl.net
Contact No: [protected],[protected]

Dear Sir/Madam,
I am very very sad in writing to you.

I gave birth of a baby followed by an operation on 21st Dec 2009 and submitted the claim documents on 9th Jan 2010. Even after passing of more than 100 days I am yet to get my claim reimbursement cheque which has been approved (As per FHP Limited details-Settled Amount: 24737,Cheque Date: 26 Mar 2010,Cheque Number: 747,Payee Name: Mr. Deepak Kumar Dwivedi ).

We communicated with KARVY,FHPL,NATIONAL INS & TPA for more than 50 times in these days for this. No one in these are ready to answer and respond towards my mails. We are quite frustated because of them. We don't know what will happen with our money?
FHPL has mailed that they have delivered the cheque to the Broker- Karvy Insurance Broking Limited. But Karvy is not responding towards it even writing to the chairman of it at last.

Therefore, Kindly help & save common people from these show called corporates.

Regards
Namita Kumari
[protected]

Note- Mail coppied/pasted of FHPL for your references-----

Dear Sir,

Your settlement cheque has already been delivered to Karvy. Detail are as follows.

Settled Amount : 24737
Cheque Number : 747
Cheque Date : 26 Mar 2010
Payee Name : Mr. Deepak Kumar Dwivedi

Kinldy get in touch with the local Karvy office for the same.

Regards,
Partha Maity
Dy Manager – Operations

Family Health Plan (TPA) Ltd.
Kolkata
Mob. - [protected]

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...

Hi,

We have been offered medical coverage by FHPL through Appollo DKV by our Orgainzation.

When ever we are in need of assistance and trying to contact their Corporate Reletions person he says he is busy, hence to contact after wards, apart from he says not to make repeated calls.

Even though it is mentioned some of the hospitals in their list of hospitals where we can have cashless treatment, when approached the hospital they says we donot have any tie-up with them, hence you pay the cash for the treatment and later go for reimbursement.

The person who is in an impression of cashless treatment available for him through this plan needs to run at eleventh hour in search of money.