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Non-Payment of Claim for Mediclaim from Bajaj Allianz Family Care First Plan

This is a discussion on Non-Payment of Claim for Mediclaim from Bajaj Allianz Family Care First Plan within the Medical Insurance forums, part of the Insurance category; Dear Sir, Please be informed that I have taken one Family Care First Mediclaim Policy of Bajaj Allianz in February ...

  1. #1
    rajeevarya is offline Junior Member
    Join Date
    Jul 2010
    Posts
    1

    Default Non-Payment of Claim for Mediclaim from Bajaj Allianz Family Care First Plan

    Dear Sir,

    Please be informed that I have taken one Family Care First Mediclaim Policy of Bajaj Allianz in February 2009.
    Policy No. is 0121316756-Family Care First.

    Unf0rtunately, my wife, Reshma Arya was diagnosed Gangrene in Intestine at Jaipur Golden Hospital, New Delhi and for
    Surgery she was refrred to Sir Ganag Ram Hospital, New Delhi. TPA Medicare is not on the panel of both the
    Hospitals, so I have paid all the expenses at both the hospitals and registered Claim after the discharge and
    setling of of my wife in the month of January 2010 amounting Rs. 1,98,301 (Rupees One Lac Ninety Eight
    Thousand Three Hundred One Only) CLAIM NO. is 03104021

    I have submitted all the desired documents alonwith my original file.

    Then I received a letter demanding some additional documents from Medicare TPA like Opertion History,
    Doctor's Summary, Printed Bill from Sir Ganga Ram Hosiptal and One Pre-Pribted Receipt of Rs. 10,000/-
    from Jaipur Golden Hospital.

    I went to both the hospitals and submitted the documents at Medicare TPA Patel Nagar, New Delhi office.
    In this matter, please be informed that I have submitted Duplicate Receipt Of Rs. 10,000/- from Jaipur
    Golden Hospital, as they told me that they can not issue the Original Receipt again and they will issue only
    Duplicate Receipt.

    Then I received a mail from Ms Malti Joshi from Bajaj Allianz that My loan has been approved and I will get
    the payout within one week time.

    But to my surprise and shock once again I received a letter from MEDICARE TPA asking for the Original Receipt
    of Rs. 10,000/- from Jaipur Golden Hospital since They say that the Duplicate Receipt is not Valid.

    I wet to Jaipur Golden Hospital once again and stated the amtter to them.

    They issue me the Duplicate Receipt and got it Stamped/Sealed and Signed from the Authorized Officer
    and also mentioned as TRUE COPY on the Receipt which I have submitted again to MEDICARE TPA Office,
    Patel Nagar, New Delhi.

    Now to my surprise and shock once again MEDIACARE has sent one FINAL REMINDER asking for the Original Receipt
    Once again.

    I told them telephonically that how the Hospital will issue the Original one, the hospital has issued the Dupliacte
    Receipt and after the Stamp and Seal it can be treated as Original one, but they have spoken to me in very
    hard way and told me that they will not settle my claim and they are closing it.

    Please look into the matter and instruct the Insurer Bajaj Allianz to settle the claim as their TPA is totally dishonest
    and they are not willing to pay the claim.

    Please find below the mail
    Thanking you

    Rajeev Arya
    65, Apna Ghar Society,
    Sant Nagar, Rani Bagh,
    Delhi-110034
    Tel: 9810421923/27031585/42644004

  2. #2
    adv.richa is offline Moderator
    Join Date
    Jul 2010
    Posts
    456

    Default Send Legal Notice

    We have gone through your complaint and suggest you to send a legal notice to both "Medicare TPA and Bajaj Allianz ", mention all the details in it, attach the photocopy of all the supporting documents and ask them for payment with in the mentioned time in the notice.
    Wait for their reply and revert to us back.
    still have a question feel free to contact us again.

  3. #3
    Unregistered Guest

    Cool Medi claim Floater Policy-reg.

    Under the floater policy my Health card No. is IHP-13-124 (Policy No. is OG-13-1908-8403-00000004)(Expiry dt.31.7.13).
    The claim amount of Rs.,36624.00 is yet to be settled.

    Please let me know further developments.

    Regards,

    Sunduararajan.G
    09448382108
    sun1955@outlook.com
    jaimaruthee@gmail.com

 

 

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