Dear Sirs,
This is to bring to your notice the misconduct by your verification officer Mr. Santosh Chand, (Emp. Code: SH34634, ID card enclosed) in April 2022 during his visits to my hospital.
He came for verification of one of the insured patient’s claims, but without any documents of the patient’s treatment in our hospital, any letter of verification from your company, or a consent letter from the patient to verify his record.
When my hospital nurse asked about the documents (all other company representatives follow this protocol), he said that it is on his mobile. So the nurse said that we need hard copies of the documents to verify and to give him a certificate of verification. In reply, he started shouting at her and saying that she does not know anything about this and he has all the right to ask for the papers. When she refused to budge, he threatened her that he will see to it that no claim from your hospital will be accepted.
He again came on the 20th of April to meet me. When I asked him to show me the documents to be verified, he said that they had sent an E-mail and that stands as a verification letter. However, I have not received any such email. During the entire conversation, his attitude was quite arrogant and rude. His objective was to gain access to patient records notwithstanding his deficiency in proving his authority for the same.
Here, it may be noted that our hospital is not on your panel and is not one of your network hospitals. Therefore we are not bound by your rules over a networked hospital where perhaps the verification officer can examine the records at any time.
We abide by the doctor-patient confidentiality clause and cannot disclose the patient’s details until we receive a documentary copy from the concerned patient and advance intimation in writing from the insurance company about the proposed visit and authorization to verify the patient’s record.
This conduct of your verification officer Mr. Santosh Chand was mentioned and highlighted in all our previous emails (17th May, 28th June, 9th July, and 19th July, and again during the video conference on 4th August) but it was conveniently ignored and neglected for the reasons best known to you.
I register my protest against this unruly behavior of your verification officer and demand an apology from him and assurance from your company that such unpleasant incidence will not be repeated in the future.
I hope you will look into this matter and do the needful.
Best Regards
( Dr.Pravin J Gupta)
10th August 2022.
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