MoolChand Hospital — Mediclaim Policy No.272300/48/2015/4547 of OIC Claim No.[protected] with Emeditek

Address:

New Delhi, Delhi

22nd May, 2015 Sub: Mediclaim Policy No.272300/48/2015/4547 of OIC Claim No.[protected] with Emeditek Dear Sir, I am writing to you with reference to admission of my son Jahid Ali aged 10 years in Moolchand Hospital, New Delhi on 16th May, 2015. He fell from height and broken his both wrists, which caused swelling and deformity b/l wrist and severe pain /bleeding from scalp. Iam holding this Insurance Policy since 2010 and had been advised by Mr J S Dham that it is a Cashless Policy and under the scheme only 10% of the total claim will be paid by me and total claim covered under Policy. “According to Policy’s Terms & Conditions:TPA shall directly settle all bills of admissible amount with the Network Hospitals and insured person may not have to pay such admissible amounts to the hospitals to the extent the claim is covered under the policy.” I would like to bring it to your attention that Moolchand Hospital overcharged me inspite of having cashless policy as mentioned above and as per Policy I am liable to pay only Co Payment 10%. Total Expenses: 47, 321.00 Claim Received: 27, 578.00 Claim No.[protected] I paid : 19, 743.00 A. Amount of Rs.19, 743/- paid by me on the day of admission & on the day of discharge – Receipts are enclosed herewith for your reference. 1.Registration Charges – Rs. 400.00 2.Hand Ap / Oblique - Rs. 375.00 3.Xray -5 - Rs. 2, 625.00 4.Admission Deposit - Rs. 10, 000.00 (adjusted on the discharge day) 5.On Discharge Date - Rs. 6, 343.00 Please note & verify that no surgery took place but Moolchand Hospital wrongly charged the following amount in the final billing amounting to Rs.17, 720/-. I demand refund of these charges immediately. Rs.8, 400/- Surgery charges Rs.9, 320/- Operation Theater According to Hospital they have charged an amount of Rs.16, 343/-, which is non-medical and non payable items & details are: 1.Category Room difference – 5, 403 whereas according to me it should be 3, 300 (2000 permissiable room category & room given was of 3, 100/- category). I was informed on the day of discharge that as per policy entitlement of Room charges are Rs.2, 000/- & they have given Rs.3, 100/- category room as they do not have other low category room. As per policy they must inform the patient at the time of admission. 2.10% Co Payment – Rs.3, 124 - Agreed by me. 3.HIV Test 814.00 – Not Agreed – why did they do this test if not permissible 4.HB1Ag – 651 Not Agreed – why did they do this test if not permissible 5.HEPC -1367 Not Agreed – why did they do this test if not permissible 6.Endoscope- 1260 - Not Agreed – why did they do this test if not permissible & what was the need of this test. 7.Recovery Room-Rs.500 – Not Agreed – he was in the hospital & they charged for Room. 8.Dietician – Rs.400 – Not Agreed- there was no need of this imposed expenses. 9.Pharmacy – Rs.735- Agreed 10.Misc – Rs.600 - ????Not understood & no explanation given by the Hospital 11.Emergency – Rs.1, 489 - Not understood & no explanation given by the Hospital You are requested to take necessary steps to reimburse amount of Rs.9, 184/- + Rs.17, 720 which is wrongly charged from me & I am therefore referring the matter to you for investigation to see if you can help/ resolve this matter else else I will move to the appropriate authorities for corrective action at their end due to overcharging/wrong charging & deficiency in services of Moolchand Hospital /OIC & E Meditek TPA. I have no other option but to take further step to resolve this issue with the competent authorities. Enclosing herewith copies of pre & post admission bills+hospitalization bills+discharge certificste of Moolchand Hospital+medicine bills total amounting to Rs.47, 321/-. Enclosing herewith copy of Saving Bank Passbook and copy of cancelled cheque for reimbursement of overcharged account. Sir, in case you need any further information or details/clarification from me, please feel free to contact me on [protected]. Thanking you, Yours faithfully, Shrafat Ali Father of Zahid Ali CC TO: 1. E Meditek TPA Services Ltd., Plot No.577, Udyog Vihar, Phase V, Gurgaon-122016 Shri Moolchand Hospital Kharaiti Ram Hospital, Lajpat Nagar-III, New Delhi-110024 2. The Officer Incharge, IRDA Grievance Cell, New Delhi 3. Consumer Affairs Department, Insurance Regulatory and Development Authority, 3-5-817/818, United India Towers, 9th Floor, Hyderguda, Basheerbagh, Hyderabad – 500 029