Heritage Health Tpa Pvt Ltd — Less amount processed n settled by heritage

Address:	Sayan Roy Heritage Health Insurance TPA Pvt. Ltd. IRDAI License no : 008 ; CIN -U85195WB1998PTC088562 Regd Office - McLEOD HOUSE, 3 N. S Road, Kolkata
Website:	heritagehealthtpa.com

Dear Sir,

With reference to below email we would like to mention following points

No prior intimation resettlement letter regarding settlement amount was send prior to claim settlement No deficiency letter letter mentioning discharge certificate not available was sent prior to settlement of claim .claim was submitted in sep 20 but still March 21 no response no settlement suddenly in week claim was settled due to complaint in ombudsman.also my amount was less processed compared to amt claim .Bill's nearly 99000 not processed by you.so I request you to processed my Bill's n as you have processed for Rs 4 00000 and at that time all documents were there.now you are telling documents went missing while processing file for buffer claim.i don't agree with you n request you to processed my pending bills of Rs 99000 as well as all dhanwantari medical bills mentioned below.your executive sairaj and soummallya das has confirmed all documents were provided to them at claim.please recheck n pay my sum left 120583 immediately.

The settlement had been done as per policy terms and conditions . Please note that the details of items which disallowed from the settlement of the claim as under:-

Rs. 1500.00 on Bill No 942 dated 13/06/2020 (ICU) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 800.00 on Bill No 942 dated 13/06/2020 (Consultant) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 1300.00 on Bill No 942 dated 13/06/2020 (Consumables) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 1082.00 on Bill No 6405 dated 29/06/2020 (Consumables) - FOOD AND BEVERAGE CHARGE NOT PAYABLE.

Rs. 1000.00 on Bill No 6405, . dated 29/06/2020 (Laboratory) - NO DETAILS ENCLOSED FOR LABORATORY CHARGE MENTIONED IN FINAL BILL OF ADITYA BIRLA MEMORIAL HOSPITAL

Rs. 1800.00 on Bill No 942 dated 13/06/2020 (Laboratory) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 500.00 on Bill No 942 dated 13/06/2020 (O2/Gases) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 1500.00 on Bill No 942 dated 13/06/2020 (Ventilator) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 500.00 on Bill No 942S dated 13/06/2020 (Monitoring Charges) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 1082.00 on Bill No 6405 dated 29/06/2020 (F&B) - FOOD AND BEVERAGE CHARGE NOT PAYABLE.

Rs. 200.00 on Bill No 942 dated 13/06/2020 (Registration) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 200.00 on Bill No 942 dated 13/06/2020 (Miscellaneous) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 830.00 on Bill No 942S dated 13/06/2020 (Miscellaneous) - DISCHARGE CERTIFICATE / TRANSFER CERTIFICATE FROM DHANWANTRI MEDICAL FOUNDATION NOT ENCLOSED

Rs. 1445.00 on Bill No 6405 .. dated 29/06/2020 (Ward Consumables / Disposables) - NON PAYABLE EXPENSES.

Rs. 10000.00 on Bill No 6405 dated 29/06/2020 (Room Rent) - ROOM RENT MAXIMUM PAYABLE RS 5000/-PER DAY EXCESS ROOM RENT DEDUCTED CLAUSE 1.2.1(A)

Rs. 395.99 on Bill No 5267 dated 13/06/2020 (Medicines by Shop) - AS PER CLAUSE NO:4.10 NON MEDICAL EXPENSE IS NOT PAYABLE.

Rs. 25072.52 on Bill No 6405, .e dated 29/06/2020 (Consumables) - AS PER CLAUSE NO:4.10 NON MEDICAL EXPENSE IS NOT PAYABLE.

Rs. 5000.00 on Bill No 6405f dated 29/06/2020 (Laboratory) - GLUCOMETER REPORT NOT PAYABLE.GLUCOMETER REPORT NOT ENCLOSED

Rs. 100.00 on Bill No 6405 dated 29/06/2020 (O2/Gases) - BMW CHARGES NOT PAYABLE.

Rs. 1500.00 on Bill No 073 dated 13/06/2020 (Ambulance) - AS PER CLAUSE NO:3.7 AMBULANCE CHARGES ARE PAYABLE UPTO LIMIT RS 2500/- PER TRIP

Hope, above details would clear you the basis of our settlement in the instant case

Regards,

Sayan Roy
Heritage Health Insurance TPA Pvt. Ltd.
IRDAI License no : 008 ; CIN -U85195WB1998PTC088562
Regd Office - McLEOD HOUSE, 3 N. S Road,
Kolkata - 700001, India
Corporate office - NICCO HOUSE, 5th Floor, 2 Hare Street, Kolkata - 700001, India
Telephone No[protected]; Fax No[protected];
Website - heritagehealthtpa.com

From: chirag nanda [mailto:[protected]@gmail.com]
Sent: Sunday, May 30, 2021 11:14 PM
To: [protected]@irdai.gov.in
Cc: Sayan Roy; Corporation Bank Heritage; Heritage Complaint; [protected]@gmail.com
Subject: I am sharing 'complaints-data-format (1)' with youPlease refer my claim carefully. My buffer amount approved is 343436 but you have processed only222583 and settled only 166766 . Why my amount rs 120853 not processed. Why only 222583 processed if limit f

Dear Sir please find complaint data of my claim for heritage IRDA chirag nanda [protected]

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DISCLAIMER : This message contains confidential information and is intended only for the individual named. If you are not the named addressee you should not disseminate, distribute or copy this e-mail. Please notify the sender immediately and destroy all copies of this message and any attachments. The recipient should check this email and attachments for the presence of viruses.

[protected] Forwarded message[protected]
From: chirag nanda
Date: Sun, 6 Jun 2021, 12:38
Subject: Re: FW: FW: FW: I am sharing 'complaints-data-format (1)' with youPlease refer my claim carefully. My buffer amount approved is 343436 but you have processed only222583 and settled only 166766 . Why my amount rs 120853 not processed. Why only 222583 processed