Lodging a complaint against Pristyn Care for misleading and defrauding us. I want to give a brief description to convey my issue.
My mother suffered from gall bladder stones. I am a defense personnel with access to the best medical facilities provided for dependents. All procedures for surgery, including anesthesia, were done by BH Delhi Cantt on August 15, 2024, but the surgery date was given as December 12, 2025. Our family decided to try for an earlier surgery; otherwise, the date of December 12, 2025, was fixed by BH Hospital.
My elder brother, who works as an IT software developer suggested trying for a dependent insurance claim through his company. We tried various insurance companies for cashless or reimbursement claims, but two companies rejected the claim. Then, a Pristyn Care staff member named Sonu Kumar called me and convinced me that Pristyn Care could manage a cashless claim without seeing the insurance document. He said that although my insurance claim was rejected twice by other companies, their company could handle the claim.
He convinced me to first go for a consultation with a Pristyn Care doctor and then decide where the surgery would be done. He gave me appointment schedules many times on WhatsApp, but I did not trust how the claim could be cashless when it was already rejected. I asked him to check my insurance claim many times; I said that I would not pay a single rupee until it was verified. He promised to provide this in writing, but after checking, no document was given.
Sonu Kumar assured me that I should not worry about payment; I only had to pay Rs 1, 500 as a file charge at the hospital as decided by Pristyn Care. This was written in messages and voice recordings on WhatsApp.
First, I consulted Dr. Anwar Hussain in Dwarka, although I suspected he was not a professional doctor. Then, I was referred to Maheswari Hospital in Rohini, Delhi, which is far from my home. We accepted it because cashless facility was available. I was told I only had to pay Rs 1, 500 to the hospital, but the hospital confirmed I did not pay any money. Maheswari Hospital accepted the case without taking any money.
The cashless claim was accepted on August 23, 2025, and a VIP room was provided. The surgery was scheduled for 12 PM on August 24, 2025. When I went for surgery, the hospital staff said a specialist doctor would operate. After surgery, I was informed that Dr. Anwar Hussain performed the surgery. If I had known Dr. Anwar Hussain would operate, I would not have gone for surgery. I am speechless.
Discharge on 25 Aug 25, there was a delay of about 3 hours due to hesitation from Pristyn Care staff regarding documentation. The hospital discharge summary was completed by 3 PM, but clearance from Pristyn Care staff was delayed for form submission online for payment. If I had been informed earlier, I would not have agreed.
I did not agree to submit the online form. If it had been sent to me in writing on your company email, I never would have paid any money. Then Pristyn Care sent a convincing mail on the company ID saying I should not worry, no money would be deducted from my account; your insurance company and Pristyn Care would handle the claim.
After surgery, returning home, my mother experienced stomach pain, gas, and vomiting. I contacted Dr. Anwar Hussain, who said these were normal symptoms and advised continuing medicine. After five days, we consulted Dr. Dharmesh Jain, a family specialist in Janakpuri, who performed the surgery. He said the liver was already infected during surgery and prescribed medication.
Later, Sonu Kumar from Pristyn Care called and said my claim was rejected and I must pay Rs 86, 000 to Pristyn Care, with a discounted amount of Rs 66, 577 to be paid immediately. I was shocked. On September 30, 2025, Rs 66, 577 was debited from my account. The online form submitted at discharge was not checked for terms and conditions, and I received no reminders before the money was debited.
If I had to pay for the surgery, why did I go to BH Hospital? If I had to pay, I would have chosen my family doctor. I trusted Pristyn Care due to its brand reputation and goodwill. You have misguided and defrauded us.
I request you to please reverse the amount and rectify this matter. I am always grateful to you.
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