Re-embursement of Mediclaim policy No. 311200/34/09/11/00000422, Member Id. N90864920

**santysri** · 07-06-2010, 03:40 PM

Sir,

This is regarding my above stated policy of The New India Assurance Company. My wife was admited in the Pushpawati Singhania Research Institute For Liver Renal And Digestive Diseases hospital, New Delhi on dated 25-jan-2010 upto 29-jan-2010 for the treatment of RECURRENT UTI, JEJUNAL WALL THICKENING , WORM INFESTATION AND (OVARIAN CYST).

Evenif it was told to us that this policy is cashless we have to pay Rs.25000/- in advance to the hospital before admission. As soon as we got admitted we did all the formalities required for mediclaim. Two days lated we got a fax saying Cashless facility of Rs.20000 for the treatment of UTI WITH PYELONEPHRITIS has been passed and Kindly send the final bill+D/s for extension.

My final bill in the hospital was Rs.38096/- thus we send all the bill+d/s for extension but in reply they said that CREDIT FACILITY DENIED FOR UTI WITH PYELONEPHRITIS WITH LT OVARIAN CYST. HENCE CASHLESS IS DENIED AND PREVIOUS LETTER STANDS CANELLED.

As our claim was denied we did arrange the full amout of Rs.38096/- by own and deposited in hospital and get discharged.

Later we submitted all the documents to the New India Assurance Policy claiming for the re-embursement on 11-Feb-2010 claming Rs.50,022/- (including all the expences done within 1month before the admission in hospital).
We got the re-embursement of Rs.40205/- on dated 18-Apr-2010.
The amount of Rs.9817/- was deducted as follows :
RS 400/- DIET CHARGES NOT PAYABLE, RS 1456/- BILL NOT ATTACHED,RS 30+5 TAP+BANDAGES NOT PAYABLE, RS 14/- DT 24/01/10 MEDICINE PATIENT NAME NOT MENTION, RS 350+482 DT 16/12/09+25/11/09 MEDICINE PRE 30 DAYS AS PER POLICY,RS 550/- (RS 50+50+50+50+50+50+50+50+50+50+50) INJECTION ADMINITRATION CHARGES, RS 10/- ID BRACELET NOT PAYABLE,RS 350/- DT 6/02/10 CONSULTATION CHARGES PRESCRIPTION NOT ATTACHED, RS 1000/- CONSULTATION CHARGES AS PER POLICY,RS 550+800+1100 DT HBSAG+HIV+HCV ELISA NOT PAYABLE, RS 750/- USG RELAITED TO OVARIAN CYSTS NOT PAYABLE, RS 370/- DT 17/12/09 LAB TEST PRE 30 DAYS AS PER POLICY,RS 1600/- ROOM RENT AS PER POLICY.

Now on dated 19-June-2010, we again claimed Rs.8899/- for the expenses we have done within 1 month of discharge and also added all the papers due to which some amount was deducted in my previous claim. But now the claim was rejected giving the reason as follows :
ON SCRUTINY OF THE DOCUMENTS, WE ARE OBSERVE AS UNDER: INSURED WAS ADMITTED ON 25/01/2010 AND DISCHARGED ON 29/01/2010 WHILE PRE & POST CLAIM DOCUMENT SUBMITTED ON 19/06/2010. AS PER POLICY GUIDELINES OF INSURANCE COMPANY CLAIM SHOULD REACH US WITHIN 90 DAYS STARTING THE DATE OF DISCHARGE OF HOSPITALISATION. THESE CONDITIONS ARE NOT FULFILLED BY THE INSURED. THIS CLAIM FALLS OUTSIDE THE SCOPE OF THE POLICY COVERAGE AND HENCE NON TENABLE (AS PER CLAUSE 11.0). RECURRENT UTI, JEJUNAL WALL THICKENING , WORM INFESTATION AND (OVARIAN CYST)

Thus I have lost Rs.9817/- in my previous claim and Rs.8899/- in this claim.
1. I have not got any guideline of insurance company at the time of insuring nither I found it anywhere on internet also.
2. Some amount was deducted from my 1st claim i.e. Diet Charges Rs.400/-, Injection Adminitration Charges Rs.550/-, Consultation Charges Rs.1000/-, RS 550+800+1100 DT HBSAG+HIV+HCV ELISA not payable should be given to me as it was all the test which come negative and was done by the doctors in the hospital to clear their doubts. It was not advised by me to do that.
3. My was was not well even after discharge and due to this I got delayed in submiting the documents for second claim. This should be given to me.

Please help me in the above matter

Santosh Srivastava
Phone No. 9211076357, 9212495617
Policy From : THE NEW INDIA ASSURANCE COMPANY, Scindia House, KG Marg, New Delhi
Policy No. : 311200/34/09/11/00000422
Member Id : N908649205
TPA : RAKSHA TPA PVT. LTD., Mathura Road, Faridabad

**gupta.amitmohan** · 07-07-2010, 11:32 AM

Respected Sir,

This is with ref to the email recieved from your Reliance General Insurance Company Ltd. as detailed below, regarding my Healthwise policy (gold) running for the last 3 years and going for renewal for the 4th Year.

Now i have been informed that i need to pay (approx) Rs. 11,000/- instead of (approx) Rs. 3000/- paid last year for renewal premium of Healtwise Insurance Policy.

Sir, Here i would like to submit that it would be impossible for a middle class man to pay such a huge difference of renewal premium for the same Health Insurance Policy.

Sir, I had 3 years back purchased this policy keeping in mind its long term cost and the respect for your esteemed company to honour its commitments and responsbilities towards the general customer.

Sir, I think this hike of renewal premium should not be forced upon the existing customers and should be kept only for the new business.

For your ref i am attaching the premium sheet that was provided to me along with the proposal 3 years back so that i can foresee my further year renewal premiums and plan my health insurance renewals accordingly with such a huge company like yours.

Sir, Please review your premium structure because this revised renewal premium would not be payable by your existing customers like the undersigned.

I hope you are not wanting your existing old customers who have supported your company and its products initially during its growth stage now to go away / or silent way of saying get out of the policy now (by not renewing the Health insurance policy at such high renewal premiums) because we are low cost enterants of your product and now you would like to have customers who can pay high premiums and thus get good returns for your company and your products.

Sir, i would once again request you to kindly review your revision of the Healthwise Insurance renewal premiums and instruct the concerned official to get in touch with the undersigned so that the renewal premiums can be paid as per the last few years premium sheet attached for your kind reference also please find attached the Gold Policy of the undersigned for your reference and kind perusal so that the same may be renewed at the earliest at the same renewal premium.

At the end i would only like to say that i would not like to exit my old heartheld policy because i would not be able to pay the increased renewal premium. kindly please do something so that your old loyal customers stay with you for long and pray for your success always.

Warm Regards

Amit Mohan Gupta
Lucknow

**gupta.amitmohan** · 07-07-2010, 11:33 AM

Respected Sir,

This is with ref to the email recieved from your Reliance General Insurance Company Ltd. as detailed below, regarding my Healthwise policy (gold) running for the last 3 years and going for renewal for the 4th Year.

Now i have been informed that i need to pay (approx) Rs. 11,000/- instead of (approx) Rs. 3000/- paid last year for renewal premium of Healtwise Insurance Policy.

Sir, Here i would like to submit that it would be impossible for a middle class man to pay such a huge difference of renewal premium for the same Health Insurance Policy.

Sir, I had 3 years back purchased this policy keeping in mind its long term cost and the respect for your esteemed company to honour its commitments and responsbilities towards the general customer.

Sir, I think this hike of renewal premium should not be forced upon the existing customers and should be kept only for the new business.

For your ref i am attaching the premium sheet that was provided to me along with the proposal 3 years back so that i can foresee my further year renewal premiums and plan my health insurance renewals accordingly with such a huge company like yours.

Sir, Please review your premium structure because this revised renewal premium would not be payable by your existing customers like the undersigned.

I hope you are not wanting your existing old customers who have supported your company and its products initially during its growth stage now to go away / or silent way of saying get out of the policy now (by not renewing the Health insurance policy at such high renewal premiums) because we are low cost enterants of your product and now you would like to have customers who can pay high premiums and thus get good returns for your company and your products.

Sir, i would once again request you to kindly review your revision of the Healthwise Insurance renewal premiums and instruct the concerned official to get in touch with the undersigned so that the renewal premiums can be paid as per the last few years premium sheet attached for your kind reference also please find attached the Gold Policy of the undersigned for your reference and kind perusal so that the same may be renewed at the earliest at the same renewal premium.

At the end i would only like to say that i would not like to exit my old heartheld policy because i would not be able to pay the increased renewal premium. kindly please do something so that your old loyal customers stay with you for long and pray for your success always.

Warm Regards

Amit Mohan Gupta
Lucknow
Mob: +91 9335225775

**adv.richa** · 07-07-2010, 01:42 PM

Originally Posted by gupta.amitmohan

Respected Sir,

This is with ref to the email recieved from your Reliance General Insurance Company Ltd. as detailed below, regarding my Healthwise policy (gold) running for the last 3 years and going for renewal for the 4th Year.

Now i have been informed that i need to pay (approx) Rs. 11,000/- instead of (approx) Rs. 3000/- paid last year for renewal premium of Healtwise Insurance Policy.

Sir, Here i would like to submit that it would be impossible for a middle class man to pay such a huge difference of renewal premium for the same Health Insurance Policy.

Sir, I had 3 years back purchased this policy keeping in mind its long term cost and the respect for your esteemed company to honour its commitments and responsbilities towards the general customer.

Sir, I think this hike of renewal premium should not be forced upon the existing customers and should be kept only for the new business.

For your ref i am attaching the premium sheet that was provided to me along with the proposal 3 years back so that i can foresee my further year renewal premiums and plan my health insurance renewals accordingly with such a huge company like yours.

Sir, Please review your premium structure because this revised renewal premium would not be payable by your existing customers like the undersigned.

I hope you are not wanting your existing old customers who have supported your company and its products initially during its growth stage now to go away / or silent way of saying get out of the policy now (by not renewing the Health insurance policy at such high renewal premiums) because we are low cost enterants of your product and now you would like to have customers who can pay high premiums and thus get good returns for your company and your products.

Sir, i would once again request you to kindly review your revision of the Healthwise Insurance renewal premiums and instruct the concerned official to get in touch with the undersigned so that the renewal premiums can be paid as per the last few years premium sheet attached for your kind reference also please find attached the Gold Policy of the undersigned for your reference and kind perusal so that the same may be renewed at the earliest at the same renewal premium.

At the end i would only like to say that i would not like to exit my old heartheld policy because i would not be able to pay the increased renewal premium. kindly please do something so that your old loyal customers stay with you for long and pray for your success always.

Warm Regards

Amit Mohan Gupta
Lucknow
Mob: +91 9335225775

Kindly provide us the reason, mention by the reliance general insurance.

Re-embursement of Mediclaim policy No. 311200/34/09/11/00000422, Member Id. N90864920

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