[Resolved]  Religare Enterprises — Religare s health Cashless Policy is a total fraud. Please avoid.

Address:

New Delhi, Delhi, 110075

Insurer Name: Ved vati
PolicyNumber:10850085
ReligareReferenceNumber: 80105499

Ved Vati (my mother) had visited Dr. S.K Srivastava at VPS Rockland Hospital in Dwarka Delhias on 5th February 2017. sHe had been suffering severe chest pain . Upon examinations the doctor advised angiography to be conducted. For the same, she was admitted to Rockland Hospital in emergency on 5th February 2017. Upon angiography, the doctors found out that she 99% blockages in a main artery and an emergency angioplasty surgery was conducted by Dr.sk srivastava as on 7th February 2017. Thankfully, the surgery was successful and she was discharged on 10 February 2017.

She had applied for star Health Insurance in Oct 2015 and the policy start date is 27th October 2015. That time the star health agent was behind our life to make the premium payment and promised tall (and subsequently I realize, farce) benefits of cashless admissions in some 100s of hospitals across India, additional benefits, blah, blah, blah. We finally gave in, premium paid, policy made and a fancy Insurance card was given. We were told that we just have to flash that Insurance card at any partner hospital for cashless admissions. And after one yar I got a call Religare and he said for portability and I have done the portability in religare that now we can transfer our health worries to them. And as stupid and naïve we were we believed.

Come 5th february 2017. I requested for cashless admission of my Mother by showing her Insurance card. The hospital thought I was dumb **** to believe that such thing ever exists. They gave a form with multiple pages to be filled and several documents to be attached. I ran from pillar to post to get the things in place. I personally visited the religare gurgaon office to take approval for cashless but I was told that a reply will be received within 4 hours. Subsequently, Religare requested for more papers and more details. This continued. Meanwhile, my Mother kept fighting for her life. Doctors told that the Angioplasty Surgery had to be performed immediately and we had to arrange Rs. 3.5 lakhs on a monday (6th february 2017). That experience was nothing short of hell. Meanwhile, our file was laying somewhere in Religare’s systems who had very conveniently asked us to surrender our health problems to them. We believed and we suffered. Finally, we managed payments with help of relatives and friends. Angioplasty was conducted successfully next Tuesday and thursday (07 February 2017) and my mother was in CCU until 10th February 2017. Till this time I had already been forced to deposit Rs. 3.5 lakhs to the hospital.

Meanwhile, Religare did wake up from their slumber and passed on my query to third party ground investigation team and the claim manager visited to hospital to meet personally with patient and doctor . As insensitive and as heartless these people could be, they sent their agent right into the CCU room of my Mother where she was lying unconscious to “enquire about the claim” and gather information and hospital bed photograph with patient. This was when the doctors had given us strict instructions to not meet the patient and we used to sit outside the CCU room for hours together to be able to get one glimpse of my Mother. Upon raising this with Ground investigator, she had this is formality to tell that she had sent an agent to just give best wishes to the patient. Really!? Is that what you people do? Are you so heartless? Then I requested her to reach me directly for any queries. Ground investigation third party agencies don’t understand that more than the patient, it is the relatives who suffer and go through mental agony. After complete the investiona again case was reinvestigate as on 8th February then kept calling me asking for almost the same documents that I had already submitted. And they kept asking me and Hospital TPA to submit same required documents. Sure, religare you are running a business. But please don’t be so insensitive, brutal and ruthless that you don’t understand that the patient’s kin have many other duties to fulfil at priority rather than replying to your queries immediately. This was not it. They again visited directly to the nurses section on the floor where my mother’s ward was and started enquiring from whoever was available at that point of time in my Mother’s room. Seriously, is this the way you work. Religare, these are your tall claims of “Ab Health Hamesha” and “Values that Bind”. Please get a reality check done on yourselves.

Finally I re-submitted the required documents and additional document from the surgeon as asked by you thru mail. Please remember this processing was all happening for CASHLESS Claim, 4 days after admission and when I had already paid Rs. 3.5 lakh. I could just cry at my desperate situation or just laugh at my stupidity of trusting Religare with the most important decision of my life.

Meanwhile, thanks to God my Mother was recovering well. Finally, on 8 February 2017, I call to customer care of Religare, and he telling me in a very indifferent note “Sir your claim for cashless has been rejected. Please contact your nearest branch if you want to file for reimbursement your amount.” With utter shock, I asked the reason. The reason he mentioned was that “they had a doubt that my mother suffered an illness before the insurance policy was made” and history of pre disease, Seriously! How lousy and shameless a reason that could. What a way to play with someone’s emotions. On further insisting, he just declined to give any comments and just said that if I have any further queries I can email to [protected]@religare[dot]com. Is that it? On real pleading, he agreed to send me an email with the reason for denial. Apart from their DOUBT, another reason they cited is that we failed to give documents of previous history of illness inspite of multiple reminders. What a shame! What a mockery of the patient. You are hell bent on proving that she was ill since years. Where do I get documents from if nothing exists? I gave them a document from the surgeon suggesting that there was no previous history. But to this, Religare said they can’t consider that letter.
With teary eyes when I told this to the surgeon, he just told me one thing – “If your Mother had been harbouring this serious illness since past years she wouldn’t have been able to make it till now. Go and tell this to the Insurance company.” I was speechless after that.
Helpless, I peronassly tell to Religare cashless team and as expected there has been no response since then. Eventually, I cleared the entire bill and got my father back home on 10 February 2017.

After this, few things are clear:
1) Religare are denying my claim on false doubts that my mother harboured an illness and diabetic patient before the insurance policy was made.
2) If Religare think that my Mother had an illness from before, why did their blood tests and other tests were completely clear?
a. That means, Religare’s claim of point 1) above is false
b. Religare did get to know that there was something wrong with my mother’s health and they still decided to go ahead with the policy, keeping us in dark. This is unlawful in any case

This incident has proved that all the tall claims by Religare for cashless admission, benefits etc are 100% total farce. Companies like these act as your best pals when they want to squeeze money out of your pockets to reach their targets. When customers require their help they are far from being helpful.

This incident has amounted not only to financial loss but also to extreme mental torture and waste of time. I assure that I will take required legal action and not give to these dastardly tactics of the Insurance Company.

Religare, I am still waiting for a response from you my reimbursement claim.

Thanks.
Policyproposer
Raj kapoor
[protected]