Religare Enterprises — Claim charges dispute

mightyg

Address:	110019
Website:	www.religarehealthinsurance.com

Hi as per my claim raised with religare ( claim number[protected] you have only approved Rs 156927.00.

However the total treatment amount is Rs 354128.00. You've stated in your explanation that you as a company don't pay for robotic surgery expenditures.

I've then provided you letter from my hospital for normal surgery amount which is around Rs 227000.

Even after providing you the value related to normal surgery you've only authorised Rs 156927.00.

I would like explanation how you've calculated this amount by email.

Please reply back within 14 days with all the facts or I will take legal proceeding.

Thanks
Mr Kumar
[protected]
[protected]@yahoo.com

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Religare Enterprises customer support has been notified about the posted complaint.

Dec 02, 2016

Updated by mightyg I had reply from your customer service who just attached the final bill from hospital with breakdown. From that particular bill here are my points. You already been provided with final bill from hospital and Open and robotic surgery breakdown of charges. Please let me know if you need any information related to charges. As your claim amount is just not right and makes no sense.

I’ve compared your approved amount against the Open surgery (Total Cost – 2, 27000) and there are following differences. You have mentioned in your approval letter

1. “RS. 60250 DEDUCTED AS PROPORTIONATE AS PATIENT ROOM ELIGIBILITY IS 3000/DAY.”
I’ve attached the bill breakdown and the maximum room rent charged for 3 days is Rs 16000.00 please provide explanation why have you deducted Rs 60250.

2. “RS.132776/-DEDUCTED AS IT IS NOT PAYABLE AS PER POLICY”

These charges are listed as ‘Robotic consumables’ in the final bill breakdown from hospital (copy attached).I understand Robotic procedure or any cost associated to this are not covered. However the Normal/Open surgery (attached) consumable costs are Rs 35000.00 and at least this minimum amount should have been covered in the approved amount.

Please provide explanation with supportive evidence or documents.
I’ve consulted my legal team and I will take this issue to court for justification and will seekReligare liable for any legal costs.