Subject: Delay and deny in Reimbursement claim
My Name: ARIT KUMAR DAS
My City: KOLKATA
My Complaint Against: Religare Health Insurance
Complaint Category: Insurance Companies
Claim Amount (Approx.): 130,000
My Complaint Description:
My father in Law ( Mr. Prafulla Kumar Dey ) made a mediclaim policy with Religare Health Insurance Company in 2015-16 period for a floater amount of Rs.3,00,000 ( Three Lakh Rs) for both spouse ( Ms. Alo Dey ) and himself and paid a hefty premium of 42K plus INR as both of them were senior citizens . He got a cerebral stroke in the month february end and was hospitalized in a Kolkata Hospital two times from 29-Feb-16 to 8-Mar-16 and then 9-Mar-16 to 14-Mar-16. That hospital did not have cashless facility with Religare. We had to pay the entire amount of about 1.3 Lakh Rs.
I had logged incident with their Central helpdesk each time and got incident ticket. I was also in touch with their policy agents Mr. Amit and Mr. Biswajit and medical representative Dr. Kisholoy Roy.
DR Kisholoy also verified with hospital and he visited the patient at home complaint release from Hospital . He discussed the mediclaim procedure with me and provided forms to be filled up and how to do so. Accordingly I filled up entire form and submitted all originals along with forms in their Kolkata office on 21-Mar-16 to Mr. Kisholoy Roy.he sent it to their HO.
On 30-Mar-16 I received a mail and call from Helpdesk that they need certain Hospital Indoor case papers and few clarifications.
I contacted the hospital and collected all relevant documents. I have laso prepared a detail clarification letter against all of their queries and despatch through Bluedart courier on 10-May-16. It reached Religare Health Insurance office on 11-May-16 around 12 Noon as per website update of Bluedart.
Post this I did not receive any update from Religare regarding status of our claims. I checked in their website claim status but it was having old status only. I started following through mail but did not get any reply. I contacted their Kolkata office at Minto Park and they provided lame excuses ( network is down now , will check and inform later etc ) etc. DR Kisholoy Roy also provided excuses that he was busy and will call me later. But I never received any call from any one.
Then I contacted their HO Noida office on 25-May-16 and discussed in detail what are the pain areas. They first told me that they have no update of receipt of my documents on 11-May-16. When I insisted then that guy contacted their internal dept and informed that the docs sent by me is not complete and need clarification. I explained that I have given all necessary Hospital papers and also detail clarifications against all their query. My explanations was checked by Dr Kisholoy and he had confirmed over mail that it was OK.
It is clear that Religare is simply harassing us and denying claim amount.
Please take appropriate action.