Paramount Health Services (Tpa) Pvt. Ltd. — Insurance claim not yet settled

Address:

524228

To

The manager,

Paramount health services p. Ltd ,

Hyderabad.



Dear sir

Reg: k. Ashok, staff code:26251 - request for settlement of claim application - reimbursement of hospitalization

Ref : claim application – ccl. No:3363610

1. Br. Lr. No:1905/03/185 dated 31.10.2016

2. Br lr no:1905/03/191 dated 22.11.2016

3. Br. Lr. No:1905/03/201 dated 10.02.2016

4. Br lr no:1905/03/203 dated 16.02.2017



With reference to the above subject we are here with informing you that we have submitted the claim application as on 31.10.2016 to our zonal office, andhra bank, ongole, but due to deficiency of documents & original bills in our claim application they have retuned the file. After obtaining all the required documents & bills, we have submitted the same to our zonal office as on 22.11.2016. After that they (Paramount tpa health services) have updated the same is on 14.12.2017. At the time of submission, we have submitted the all original bills and request letter regarding delay submission and reasons for not giving prior intimation to the paramount health services. Even thought we have submitted the above documents & bills to the paramount health, but they have generated the following quarries

1. Delay letter from insured, stating reason for both delayed intimation & submission.

2. Original balance receipt of final hospital bill with bill number & receipt number.



But we are informing that the above documents & bills are already sent on 22.11.2016 along with claim application. First time they have misplaced the above documents. Many times we have contacted to mr vijay who is working in paramount health services office, hyderabad, but they have not responded properly and also informed that once again submit the above documents. It is very difficult to get the original bills and submitted the same to paramount health services as on 10.02.2017. After that many we have called to paramount office, hyderabad and many times we have mailed to mr vijay, who is working in m/s paramount office, hyderabad, but nobody has responded. After one and half month they have rejected the claim application with the following



The patient presented with complaints of abdominal pain during pregnancy on 07.09.2016 at apollo speciality hospitals, nellore. He/she was diagnosed with prmimi with short pelvis/elective caesarean section,. The submitted documents indicate surgery under sa was administered. The discharge submitted/retrieved in the documents indicate. The claim is declined as the mandatory deficient were not retrieved/partially retrieved. Hence, the claim is being denied under clause no. Of the policy.



But we have submitted the all the above documents to paramount health services. After 5 months from the date of submission (I. E 31.10.2016) of claim application they have rejected the claim application as on 24.03.2017. After that we have called to paramount health services, hyderabad (I. E mr vijay). They have asked the particulars of the claim application and we have given clear detailed picture of above claim application. They have verified the claim application and find out the deficiency document at their end. They have informed that (Telephonic call) they have missed to submit the some of the documents to m/s united india insurance co. Ltd (Which is available in their office) and also informed that they will re - send the missed documents to m/s united india insurance co. Ltd. As per information given by the mr vijay, we have confident about to sanction the claim application. After that many times we have called & mailed to m/s paramount health services staff, but nobody is responded properly. This month 05.04.2017 we have received call from one of the staff member of in paramount health services regarding claim application and they have informed that once again we have to submit the requisition letter regarding delay submission & prior intimation, but we have informed them, we have already submitted the requisition letter 2 times i. E 22.011.2017 & 1.02.2017. They told us once again you have to submit the same requisition letter. After that the same was submitted as on 03.04.2017. After that also we have called & mailed to m/s paramount health services staff many times, but they have not responded properly. It is very difficult to facing all this non-sense creating by the m/s paramount health services. As per m/s paramount health services portal presently my claim application is rejected, but orally they have informed that it is in under process. Till now we don’t have any update regarding our claim application.



Hence, we request you to settle the claim as soon as possible. If it is rejected, how you are rejected our claim application without giving proper reason for rejection. Please give the proper reason for rejecting the claim application, even though we have submitted the required documents & bills and gave the clarifications for all the quarries generated by the m/s paramount health services.



As per irda rules & regulations, every year we are paying insurance premium to m/s united india insurance co. Ltd, then how you are rejecting our claim application without scrutinising the documents & bills. Still you are negligible towards us for answering our calls & mails, then inform us whom should we contact and how should we contact you, show as a way to approach you and talk to you.



We have submitted all the documents you asked, even though we have submitted all the documents you asked, your team has misplaced them. Again we has to get all the documents and it has been a metal struggle for us from the past couple of months. It is not

Fair to reject the claim application without intimating me as i have submitted everthing you asked.



Hence, i hope you will recheck my claim application and process it further, otherwise i will be proceeding legally as per irda rules & regulations.









(K. Ashok)

Staff code:26251

Manager,

Vinjamur,

Andhra bank,

S p s r nellore,

Andhra pradesh.