Vidal Healthcare Tpa — claim as pending/rejected for 3 months with no formal justification

Address:	Whitefield, 560032
Website:	www.vidalhealthtpa.com/home.html

The claim was submitted for my wife mrs. Harlene mary d'souza claim no.: blr-0619-cl-0008796 & i am summarising the entire experience below, so kindly bear with me.

My wife was admitted to apollo multi-speciality hospital in 2 instances at the start of june. Her first instance was completely paid (Approx. Inr 60000/-) as cashless from bajaj allianz tpa leaving around inr 2000/- as non-medical charges that i had paid. For her second instance of hospitalisation, she had to undergo a surgery due to which the overall bill came up to inr 205583/- from which cashless from bajaj tpa covered inr 146750/- as the remaining balance in the 2lakh policy. The hospital mentioned that a 2nd policy (Vidal tpa) can be claimed only through settlement and not cashless, so i paid inr 51187/- for the hospitalization and around inr3800/- for medicines (All bills submitted). The same week of discharge from the hospital, i traveled to vidal office at whitefield with all the hospital bills and required forms filled to submit the claim directly. I had received an acknowledgment mentioning all the documents were submitted. However, since then i have had to visit the whitefield office around 4-5 times as there was an apparent shortfall of documents. I had given the entire file at the beginning to the employee asking to take all the documents as i can't travel 20kms one way just to submit documents, again and again, rather take whatever is essential. However, i did everything i could to ensure there is no delay or backlog from my end. When asked for an alternate mode of communication, i was not provided any email address nor any direct line to the bangalore office. Firstly, if i have submitted all the documents to your direct employees there should never have been so many instances of the shortfall at all.in the last week of august, i received another shortfall letter on my email which i responded with the document requested from bajaj tpa. Finally, as per my conversation with an agent from your customer care in the last week of august, i was informed that all the required documents are processed and the claim is approved and the money would be disbursed within 10-14 working days.

I patiently waited and i called on 14th september to get an update on the disbursement of funds. However, to my shocking surprise, the rep informed me that the claim has been rejected. When asked for the reason, she mentioned that it's just rejected due to non-medical charges. When asked for a supervisor, she mentioned that there is no supervisor but she will arrange a callback in 30 mins and took down my number. I waited for 3 hours and called again at around 5 pm, this time the rep that spoke to me said that the claim is not completely rejected and if i need a supervisor he will arrange a callback within 30 mins; there was no call from the supervisor whatsoever. I followed up again on 16th september and briefed the rep of the entire situation for which empathetically she transferred my call to the bangalore team who then connected me with a supervisor 'meena'. I explained to her the entire situation and requested claim status clearly as being denied earlier. She mentioned that the claim is rejected as reason was non-medical expenses. However, when i asked her why was i not updated regarding the status of the claim or the segregation of charges amounting to inr 55000/- considered as non-medical; she mentioned that she will get in touch with the back-end team and contact me regarding the same at the earliest. I waited for 4 days and got no revert from anyone at vidal. I contacted vidal again on 20th and was contacted by another supervisor; he mentioned the claim has been rejected as non-medical expenses and when asked for the segregation of charges or the reason why i am not intimated about the claim status whatsoever he mentioned that 'the claim is rejected' and asked me to write an email to you for further clarification. I have attached a copy of the discharge summary and the claim covering letter along-with this mail as i refuse to accept that non-medical charges can amount to about inr 55000/- during her hospitalization, as i can see it is computed to about inr 6500/-. I am not aware if this a scam, or a system error or what exactly, as i am not being informed clearly about the claim whatsoever apart from the inconvenience i have faced at every stage where your own employees have not followed their sla's.