United India Insurance Company [UIIC] — disallowed amount in mediclaim pending reimbursement despite submission of required report.

Address:

Mumbai City, Maharashtra, 400083

I preferred a claim under policy no. [protected]p[protected] in the name of m n subramanya. The tpa is vidal health, mumbai. The claim number is mum-1017-cl-0006194 and settlement no. Is mum-0518-cr-000398 and amount settled is rs. 144733.

While settling the claim, an amount of rs. 8800 is disallowed for non submission of original report of pace maker.

I may inform you that, subsequently i submitted the original report by contacting the hospital, on 16.5.2018, vide courier no. Kur[protected] of professional courier, which was delivered to the tpa on 18.5.2018. I subsequently kept contacting the tpa, who confirmed the receipt of the original report and assured to reimburse the amount at the earliest. This happened on many occasions. Finally, on 4.9.18, the tpa shockingly informed that they have not received the report.

I made a detailed letter to the tpa on 4.9.18, explaining the details of conversations i had on various dates, where they confirmed continuously about availability of the document. I also enclosed the courier receipt, proof of delivery and also xerox xopy of the required report.

I referred the matter to the grievence officer, customer care dept o[censored]ni ii, on many occasions. I have not heard from them.

I approached the pace maker company to furnish another copy, for which they informed that the records are old and not available. Hence i requested the insurance company/ tpa to settle the matter based on the copy furnished by me, as it is the fault of tpa. Nothing has been done.

I am a retired sickly person and unable to run around. The amount is substantial for me.

An amount of rs. 2533 is dis allowed, as cost of glucomter strips are permissible.

Kindly peruse the matter and arrange for reimbursement of the said rs. 8800 and 2533, immediately.

Thanks.

Yours faithfully
M n subramanya