[Resolved] Max Bupa — not providing logical verdict | |||
Dear Akosha team I just want to describe my grievience I am using max bupa 'Health Companion - I' policy as per my policy no: [protected]. I have claimed for reimbursement of my wife Devika bhattacherjee's operation as per your claim number 90509 reported to you dated[protected]. On 20-Aug-2014, I came to know that my claim is denied for reasons as per email. on writing mail to max bupa they replied that case rejected as i have 7 year history of same but we have no such history it was wrongly entered by hospital staff that is why my pre authorization request was denied and now claim is also being denied there are ir-responsive staff of max bupa in hospital They never analyze all documents dear it is very clear and logical point that my wife deliver healthy baby on 25th sep 2013 as per documents supplied to max bupa, if she has"UTERUS VAGINAL PROLAPSE" how she can conceive and deliver healthy baby that too normally. Please look into case properly, I hope you will understand and provide logical justice Regards Abhijit Was this information helpful? | |||
Aug 14, 2020 Complaint marked as Resolved | |||
 3 Comments | |||
Comments
To,
Max Bupa
Sub.: Denial of Claim No.
95841without proper justification.
Dear Sir /
Madam,
This is to
bring your kind notice that I had purchased your Heartbeat Silver Health Policy
No. [protected] on 10.08.2013 valid upto 09.08.2014 via policy bazaar.
I suffered
from Fever (Malaria) and got admitted in Arogyam Hospital at Kharghar, Navi
Mumbai. As per policy terms and
condition, I intimate Max Bupa about my hospitalization in advance, (Intimation No. 853645).
After
discharged on 18/07/2014, I submitted reimbursement claim of Rs. 34, 516/- (Claim No. 95841)
Surprisingly,
after few days I got reply that my claim was not approved with reason stating “Allopathic Treatment done by BAMS
Physician”. I have reported the above matter to you several times (E mail
correspondence attached) but despite all my pleadings you have never reply with
satisfactory answer which is indeed regrettable. On account of your aforesaid
dereliction of duty and failure and neglect to rectify the same I have suffered
losses / incurred expenses.
BAMS doctors
can practice modern / allopatic medicine. To support my statement I am
attaching following:
1.
According
to the privileges in the Drugs & Cosmetics Act 1940, Rules 1945 Sec
2ee(iii), States have right to allow BAMS doctors to use modern medicine.
2.
Judgment of Hon’ble Supreme Court of
India vide Civil Appellate Jurisdiction Civil Appeal No. 89 of 1987. which
clearly mentioned that BAMS physician is eligible to practice the modern system
of medicine which is known as allopathic system of medicine.
As per my claim no. 95841 amount of Rs. 34, 516/- you are
liable to compensate to me. You are hereby finally called upon to pay
compensation for financial loss suffered due to your negligence in the sum of
Rs. 34, 516/- with interest within 5 days of the receipt of this notice failing
which I shall be constrained to initiate against you for redressal of my
aforesaid grievances and recovery of aforesaid amount such proceedings, both
Civil and criminal as are warranted by law, besides filing a complaint under
the statuary provision of The Consumer provision, 1986 exclusively at your own
risk, cost, responsibility and consequences which please note.
Satish
Kale
Place :
Navi Mumbai
Date: 27/10/2014
Max Bupa
Sub.: Denial of Claim No.
95841without proper justification.
Dear Sir /
Madam,
This is to
bring your kind notice that I had purchased your Heartbeat Silver Health Policy
No. [protected] on 10.08.2013 valid upto 09.08.2014 via policy bazaar.
I suffered
from Fever (Malaria) and got admitted in Arogyam Hospital at Kharghar, Navi
Mumbai. As per policy terms and
condition, I intimate Max Bupa about my hospitalization in advance, (Intimation No. 853645).
After
discharged on 18/07/2014, I submitted reimbursement claim of Rs. 34, 516/- (Claim No. 95841)
Surprisingly,
after few days I got reply that my claim was not approved with reason stating “Allopathic Treatment done by BAMS
Physician”. I have reported the above matter to you several times (E mail
correspondence attached) but despite all my pleadings you have never reply with
satisfactory answer which is indeed regrettable. On account of your aforesaid
dereliction of duty and failure and neglect to rectify the same I have suffered
losses / incurred expenses.
BAMS doctors
can practice modern / allopatic medicine. To support my statement I am
attaching following:
1.
According
to the privileges in the Drugs & Cosmetics Act 1940, Rules 1945 Sec
2ee(iii), States have right to allow BAMS doctors to use modern medicine.
2.
Judgment of Hon’ble Supreme Court of
India vide Civil Appellate Jurisdiction Civil Appeal No. 89 of 1987. which
clearly mentioned that BAMS physician is eligible to practice the modern system
of medicine which is known as allopathic system of medicine.
As per my claim no. 95841 amount of Rs. 34, 516/- you are
liable to compensate to me. You are hereby finally called upon to pay
compensation for financial loss suffered due to your negligence in the sum of
Rs. 34, 516/- with interest within 5 days of the receipt of this notice failing
which I shall be constrained to initiate against you for redressal of my
aforesaid grievances and recovery of aforesaid amount such proceedings, both
Civil and criminal as are warranted by law, besides filing a complaint under
the statuary provision of The Consumer provision, 1986 exclusively at your own
risk, cost, responsibility and consequences which please note.
Satish
Kale
Place :
Navi Mumbai
Date: 27/10/2014
Dear er.abhijit79,
Thanks a lot for bringing up the concern. However, for us to be able to help you out, we would need a few details regarding your complaint. We have specifically designed a form which will ask you for all the necessary information, which can be accessed by going to our website http://www.akosha.com/homeform.html. We request you to file your complaint with us there. You can also file a complaint by calling[protected]. We look forward to helping you out.
Regards
Akosha Team
Thanks a lot for bringing up the concern. However, for us to be able to help you out, we would need a few details regarding your complaint. We have specifically designed a form which will ask you for all the necessary information, which can be accessed by going to our website http://www.akosha.com/homeform.html. We request you to file your complaint with us there. You can also file a complaint by calling[protected]. We look forward to helping you out.
Regards
Akosha Team
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