Reliance General Insurance — application for the claim from my health policy

Address:Hyderabad, Andhra Pradesh
Website:www.religarehealthinsurance.com/Cashless/Treatments

Dear Sir/ Madam,
1. I was a policy holder of RGICL for the past three years. I took this policy in January 2014 and since then I was paying the desired amount every year without fail for getting my policy renewed.
2. Last year in the month of April I was diagnosed with the problem of a bulky uterus as there were some symptoms visible related to that. My family doctor Dr Nilam Jain who herself is a Gynaecologist, advised me to contact Dr Yogesh Mishra and Dr Pooja Mishra at Hanumant Endosurgery regarding the problem.
3. There I was told to get an ultra sound in which it was clearly visible that my uterus was badly enlarged and I was advised to get my Hystectomy done. The report for the same was attached to the claim form.
4 Further the process of my investigations started for which the reports and the bills were already sent with the claim form
5. Finally I got admitted to Hanumant Endosurgery Center on 16th of June 2017.
6. On 17th June I got my Hystectomy done which was later sent for biopsy. Post surgery I was transfused with one unit of blood and was also put on oxygen for three to four hours. The report and the bills for the same were enclosed with the claim form and sent to Reliance general insurance.
7. On 20th June 2017 I was discharged from Hanumant Endosurgery Center wherein I was given the discharge summary and the medical prescription by Dr Pooja Mishra. which was also sent to Reliance general health insurance.
8. On 20th June 2017 I made the first phone call to your RGIL for intimating about my surgery and how to proceed for the claim. In response to that I received a mail containing the claim form.
9. I filled up the form and enclosed all the important documents with it as per the list that was mentioned in the form and despatched the entire file through speed post on 18th July 2017 at 16:45 p.m.
10. The only document that I missed out was a cancelled cheque which also I had sent on 25th August 2017 at 13:15 p.m. through speed post. The details of my cancelled cheque dated 22nd August 2017 are as under- Bank - HDFC Bank, A/C no [protected], Cheque no. - 000021
11. On 22nd July I got a mail from their end stating that all the documents have been received and my claim has been registeed.
12. On 31st July 2017 a mail comes to me stating that you are requested to send the original documents within 15 days from this day.
13. On 17th August a mail comes to me asking me to send the requisite documents.
14. It had been umpteen times that I had been requesting for my claim and informing the concerned authorities that a verifying agency by the name of Brain Bird had collected all my IPD papers with vital chart, nursing chart, progress sheet, daily order sheet with SPO2 CHARTING for all days with first assessment sheet and emergency note. The scanned copy of the receiving given by that verifyoing agency was also sent to them.
15. I was also asked to submit the past history of all my problems, so in that case I would like to draw your attention on some facts. I was detected with diabeties mellitus in the month of May 2017, Hypertension was diagnosed in the month of April 2017 so how can I send my past history of these ailments.
Sir, I fail to understand that I am asking for my claim against the surgery that I had gone through and not for the then detected blood sugar which till date is absolutely normal and a certificate for the same has been given by my family doctor Dr Nilam Jain.
16. In the end I would like to request you once again that if your organisation finds my case to be genuine then kindly help me in getting my claim reimbursed bacause now all my hopes are on you people. I am a single lady who is fighting for my claim for the past one year. I beg you again to help me out.
Thanks
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Reliance General Insurance customer support has been notified about the posted complaint.
Complaint comments 

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Dear Sir/ Madam
This is in reference to my complaint against Reliance General Health Insurance for not giving me my claim. In context to this I would like to draw your attention to the mails that I had received on 31st May, 2018. The first maal sent to me at 1:52 stated that the company has received all my documents and they have registered my claim and immediately after that I am receiving another mail at 2:59 saying that my claim of Rs 103066 has been rejected. I fail to understand as to why the organisation is playing with me.
Sir/ Madam I request you to kindly look into the matter and help me in getting my claim amount. I am hereby enclosing an image of the mail that was sent to me by RGICL

1:52 PM (10 hours ago)


to me


Date: 31-May-2018
Dear Member,
Ref : Policy No.: [protected],
Inward No.: CL-[protected]-07,
Claim Status: Claim documents Received
This mail is in reference to the claim documents for HealthGain, Policy Insured Mr. /Ms NIVEDITA SAHAI bearing Employee ID .
We would like to inform you that the documents have been received at our end and the claim has been registered with inward no. CL-[protected]-07.
The details of the case are as follows:
Employee/Proposer Name : NIVEDITA SAHAI
Employee ID :
Patient Name : NIVEDITASAHAI
UHID :[protected]
Policy Period : 01 Feb 2017 to 31 Jan 2018
Claim is under process & will take 15 days for further processing from the date of receipt of claim documents.
For any assistance, please contact us at the address/email mentioned below.
Please quote Inward No.: CL-[protected]-07 in all your future correspondence.
Yours Sincerely,
Team RCare Health
Reliance General Insurance Co. Ltd.

2:59 PM (9 hours ago)


to me


Date: 31-May-2018
Dear Member,
Ref : Policy No.: [protected],
Claim No.:[protected],
Status: Rejected
This mail is in reference to the claim request of above mention policy. We are in receipt of the documents submitted by you for HealthGain, Policy Insured Mr. /Ms NIVEDITA SAHAI bearing Employee ID N/A in support of the claim.
On perusal of the claim & other document, we regret to inform you that we are unable to process the claim. Rejection letter attached with this e-mail provides more details for your reference.
The details of the case are as follows:
Employee/Proposer Name : NIVEDITA SAHAI
Employee ID : N/A
UHID :[protected]
Patient Name : NIVEDITASAHAI
CL Number :[protected]
CL Status : CL Rejected
Claimed Amount : 103066.00
For any assistance, please contact us at the address/email mentioned below.
Please quote Claim No.:[protected] in all your future correspondence.
Yours Sincerely,
Team RCare Health
Reliance General Insurance Co. Ltd.

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