Subject: Denies Cashless facility & Delay and deny in Reimbursement claim
My Name: Susant Sahoo
My City: Bhubaneswar
My Complaint Against: Religare Health Insurance
Complaint Category: Insurance Companies
Claim Amount (Approx.): 270000
My Complaint Description:
My brother Mr. sudhir sahoo made a mediclaim policy with Religare Health Insurance Company in 2014-15 period for a floater amount of Rs.8,00,000 ( eight Lakh Rs) for family and himself and paid a hefty premium of 42K plus INR. He got a Lungs problem in the month february end and was hospitalized in a AMRI Hospital, Bhubaneswar as it is a networked hospital from 15-Feb-16 to 3-Mar-16. At the time of admission Religare did not provide cashless facility. We had to pay the entire amount. I had logged incident with their Central helpdesk each time and got incident ticket. I was also in touch with their policy agents.
TPA also helped us in all regards like what they have asked they gave. I also gave all the documents they asked every time.
During the period of hospitalisation and also after discharge their agents had come and taken all the documents including indoor papers. After some days 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 Religare Health Insurance office(Regional). So many times I have contacted to Religare Customer Care… but they told me that due to Hyper tension your claim has been rejected.
But it is a matter of fact that we don’t have Hyper tension or any Hyper tension related treatment had been done during the hospitalisation period. Also three times treating doctor also had given that there is no such symptoms of Hyper tension found from the Patient where ever I also informed to customer care that If you are denying to settle our claim for the reason of Hyper tension then on reply I asked them to send your doctors/team to test whatever tests they like… but they remain silent .. I also so many time requested them to forward my call to the claim department/section , they denied and informed no one is allowed to talk with the claim team. Religare did not have the transparency procedure, they just want to opt out.
in the period of hospitalisation to end of April 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 also contacted their HO Noida office and discussed in detail what are the pain areas. They first told me that they have no update of receipt of my documents. 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 including treating doctors letter. My explanations was checked by Dr.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.
Policy holders name – Sudhir Sahoo
policy – 10477976
client no. – 52917365