Heritage Health Tpa Pvt Ltd — Claim

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Health Insurance TPA

I am to state that I am a bank employee with ID 59481. My policy No. is HHS1.[protected]. My name is Sandhya Kalathil. My mother-in-law, T.P.Vijaya is a Ovarian cancer patient. She is taking her treatment at Yashoda Hospital, malakpet, Hyderabad. She recurred cancer due to which she was advised chemo by the doctors at Yashoda hospital. After recurrence, she underwent 2 cycles from my earlier insurance support (United India Insurance Company Limited with Health Insurance as ) cashless treatment. In the two cycles, no amount was deducted and the entire amount was settled to the hospital by the insurance authorities.
While things stood thus, my insurance got renewed with National Insurance Company Limited with Heritage as TPA from 1st October, 2020. As usual, my mother-in-law underwent chemo in the month of October, 2020 but, to my utter surprise, the whole amount of treatment is not settled with hospital and some amount towards " CHEMO ADMINISTRATION AND INFUSION CHARGES RS.2, 250/-, CANULA CHARGES APRETERO 125 MG KIT and other expenses totalling Rs.6, 922/- was not paid by the insurance authorities on the ground that it is "NON MEDICAL EXPENSES".
I kindly request you to clarify me how can the above expenditure be categorized as non medical expenditure when it is used for medical purpose. When the company pays money for chemo medicine, then the medicine has to be infused. So, infusion charges cannot be categorized as Non Medical expense when the expenditure towards medicine is categorized as Medical expenditure. Further, the tablet, APRETERO will be given at the time of chemo to prevent the side effects of chemo. This is also a medical expenditure. This medicine cannot be taken in a casual manner. It is has to be administered only at the time of chemo. Then how can this amount be categorized as a Non Medical expenditure. Further, the amount spent for syringes etc. all are used for medical purpose. All those amounts cannot be categorized as Non Medical Expenditure.
In this regard, I requested the Heritage TPA office through the grievance cell to look into the issue and reimburse me the amount of Rs.6, 922/- spent by me. My complaint was also registered vide reference No.HHS.NIC.W.950243 on 17.11.2020. I many a time tried to see the status of my complaint through the website of Heritage Insurance policy, but there is no option in that website for viewing the status of the grievance except for giving grievance. Further, there is no response from company also. In this regard, I request you to issue necessary instructions to the concerned to go through the entire case record and reimburse me the amount of Rs.6, 922/- paid by me to the hospital authorities.

With regards

Sandya.K