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Claim amount not reversed completely.

This is a discussion on Claim amount not reversed completely. within the Medical Insurance forums, part of the Insurance category; Hello, I am UHG Policy holder and I have this policy on behalf of my current employer. So we can ...

  1. #1
    Unregistered Guest

    Default Claim amount not reversed completely.

    Hello,
    I am UHG Policy holder and I have this policy on behalf of my current employer. So we can that it is a cooperate policy. Under this I have declared my wife as a dependent and now after child delivery, I have submitted the medi-claimn for same.

    While submitting the claim, I have taken the help from the sample docuemtn given on their website. During submitting the hospital main bill, hey have requested to break-down the whole payment and for that they have mentioned various categories in their sample bill. I have taken help from that and got same categories on original bill. Now when I have submitted the claim, they have reject the amount of 1500/- by saying that it is non-medical category. the title given was Admission Charges. Same has been given on their sample paper - published on their website.

    My query was, if it is non medical and their policy not approve this category, then why they have published on their help documents on their website. Any policy holder will take help only from those docuements. If they are misleading then it is not fault of policy holder.

    After so many email, calls and discussion with their customer care & executives, I have not received that 1500 amount and they always reject my request my giving same excuse. I am very much frustated and tired due to running behind them. I have fulfilled all the paper work they need, but after so much mental harassment- I am helpless

    Additional Ref: Claim Reference No. 371463/1
    Please help me in this case
    Rohan
    9871704311

  2. #2
    Raviprakash is offline Senior Member
    Join Date
    Jan 2010
    Posts
    131

    Default

    Rohan, If you would please call me, on 09448120373 I may be able to help you. I need some more details about your bill.
    1. Name and address of the Insurance Company.
    2. To whom you have submitted the bills. Is it to the TPA (i.e., mediator) or to Insurance company directly
    3. Do you have any written communication from them (TPA or Insurance Co.) justifying their repudation. Oral repudations and emails may not help.
    4. No hospital has Rs. 1500/= as Admission Charges.
    5. Whether the hospital bill actually says Rs.1500/- as admisson charges? or is it you who copied it from their sample bill without verifying with the hospital concerned?
    6. What is the sum assured? What is the disease condition for which admitted? and what is the total bill amount?
    7. I would also like to hear from you and see the break up of hospital bill.
    8. Did you go to a networked hospital or a non-networked hospital
    9. Did you receive any cashless benefit or you have paid full cash at the hospital counter?
    10. How long have you been having this policy? Meaning whether the policy is in force in its first year of operation or second or subsequent years of operation?
    11. If you think that you have been misled by their sample paper on the website, I dont think it is a strong reason to go against them or claim the rest of the money only on this single count. You should have thought before submission. nevertheless, if the bill proper does not mention that Rs. 1500/= is admission charges, then you can catch them saying that I want to resubmit the bills for reconsideration.
    12. Admission charges come under disallowable category (Non-medical as they and you prefer to call it)

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