[Resolved]  Religare Enterprises — Health insurance policy no : 10026371 proposer name : chayan kanti dhar patient name : chiradeep dhar

Address:122009
Website:www.religarehealthinsurance.com

Client no[protected]
Proposer name : chayan kanti dhar
Patient name : chiradeep dhar - 15 yrs

Dear sir/madam,
My son was suffering from very high fever for few days and under treatment of a private doctor. But fever was not coming under control and he lost orientation on[protected] at 11:30pm / mid night. Seeing his sense less condition and abnormal body orientation, we took him to nearest ils hospital, emergency dept. [ one of their listed network hospital of agartala, tripura]. He was put under immediate treatment and admitted. But for admission documentation/ paper/ payment etc, it was completed at 12:45am (27/[protected]. So as per computerised record, it is already[protected]. Since his admission, he was under treatment. He was ultimately diagnosed urti and put on treatment. As his final exam of class viii is scheduled from[protected], on our request we got him discharged on[protected] at 4:30 pm to make an attempt to sit for final exam. Treating doctor agreed to discharge on condition and given a treatment plan. We took risk as we have a doctor relative available on requirement. But ultimately he could not sit for final exam.
As per religare insurance company, its is a day-care so rejected. How a emergency medical care in the mid night of 27/[protected] is a day care? My policy is not covered under emergency medical requirement? It appears to me it's fraud insurance company, if emergency medical requirements are not covered. We haven't claimed since we took policy i. E, last 6 years. Now, when we needed during emergency medical treatment purpose, they rejected a claim of rs. 12699/- saying -

We feel regret to inform you that we already has been cross verified your documents and found that the claim against chiradeep dhar are not payable according to policy terms and conditions.

• as per the submitted documents the hospitalization is less than 24 hours and the treatment taken does not fall under day care list. Hence, we regret to inform you that your claim is repudiated.

• hospitalization < 24 hrs

This is a fraud insurance company?, need to refer to regulatory authority. They are saying emergency medical requirements is not covered under policy? What for medical insurance?

I, once again request and look forward that company to settle my claim immediately else i am to refer it to regulatrory authority and consumer court
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Jun 16, 2017
Complaint marked as Resolved 
Religare Enterprises customer support has been notified about the posted complaint.
Verified Support
May 16, 2017
Religare Enterprises Customer Care's response
Hi,

Thank you for writing to us. As confirmed from the respective team, we regret to inform you that we stand by our decision as communicated to you in our previous communication dated May 08, 2017.

In case of any further concern you may please write into us at [protected]@religarehealthinsurance.com

Thanks & Regards,
Team Religare
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