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Thread: Mediclaim (New India Assurance) Complaints

  1. #1
    Unregistered Guest

    Default Mediclaim (New India Assurance) Complaints

    Dear sir / Madam

    I am insured under mediclam insurance policy of New India Assurance Co. Ltd whose TPA is Raksha TPA Pvt. Ltd.

    I was hospitalised from 31st October,2010 to 03rd November, 2010 whose documents for claim settlement were submitted in the office of TPA. After talking to them many times and even going personally several times, i am not getting any responsible answer from there. Every time I am told that your claim will be settled shortly.But after a time span of 7 months till today I am not assured that my claim will satteled or not.

    Insured Name Patel Rameshbhai Prabhudas

    Policy no. 112500/34/10/11/00012074


    Then finally on 24 december 2010 I got one letter from the TPA that your claim is NON TANABLE for reason (Reason : We have received your claim documents. As per documents available, patient was admitted in hospital with the complaints of LEFT CEREBELLAR TUBERCULOMA WITH LEPTOMENINGEAL ENHANCEMENT IN LEFT PARASAGITTAL, FRONTOPARIETAL REGION. Patient was admitted admitted for evaluation purpose only without active line of treatment. Hence, this claim stands repudiation under clause 4.4.11.

    Clause 4.4.11:- Diagnostic, X-Ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home. LEFT CEREBELLAR TUBERCULOMA WITH LEPTOMENINGEAL ENHANCEMENT IN LEFT PARASAGITTAL, FRONTOPARIETAL REGION)

    This reason is baseless the we donít go for any active line treatment. At that sudden point of we follow all the instruction by medical staff of concern hospital.

    I have letter from hospital regarding the same. In discharge card its clearly mentioned that
    1) Papatient was referred from private nursing home.
    2) Weakness of leftside of body.
    3) Fever since last night

    So I am requesting you to please help me out to get justice in particular case.

    Attachment :

    1) Claim form
    2) Letter from hospital
    3) Complaint letter
    4) Letter from consulting physician.

    Sir, this kind of attitude is not expected from an Esteemed Co. like them.
    I hope I'll get some help through your forum.

    Policy Details of :Patel Rameshbhai Prabhudas
    Policy Information
    Insurance Co.Name The New India Assurance Co. Ltd. Corporate Name Individual
    Proposal Date 24-NOV-2010 Policy No 112500/34/10/11/00012074
    Policy Start Date 24-NOV-2010 Employee No
    Policy End Date 23-NOV-2011 Raksha ID No N9011433028
    Agent Code 833/88689 ID Card Status Renewal Letter Issued
    Endorsement Date Endorsement No
    Insured Name Patel Rameshbhai Prabhudas Address Room No-1, Ramshran Yadav Chawl, Shivaji Nagar Village Malad [E], Mumbai Dist. : Greater Mumbai, Maharashtra_400097
    Photo Status Photo Not Received 64 VB Satus 64 VB Received
    Insurance Coverage Rs. Coverage Type
    E-Mail ID NA
    Click here for
    Print E card
    Claim Detail
    Cashless Information
    Complaint Regarding ID Card

    Insurance Details
    Name of the Insured Relation with Insured Age Amount Covered
    Patel Rameshbhai Prabhudas Self 44 120000
    Patel Niruben R. Wife 43 115000
    Patel Kinjal R. Daughter 22 120000


    CLAIM STATUS

    Claim No. 9021011115495
    Memberid N9011433028
    Unique Policy Number 112500/34/09/11/00011432
    Insured Name Patel Rameshbhai Prabhudas
    Patient Name Patel Kinjal R.
    Relation Daughter
    Admission Date/ Discharge Date 31-oct-2010 / 03-nov-2010
    For the Treatment of LEFT CEREBELLAR TUBERCULOMA WITH LEPTOMENINGEAL ENHANCEMENT IN LEFT PARASAGITTAL, FRONTOPARIETAL REGION
    Hospital Name Kokilaben Dhirubhai Ambani Hospital & Medical Research Centr - null
    Claim Received Date 22-NOV-2010
    Claim Amount Rs. 57246/-
    Document Check List
    Claim Processing Date
    Reason for NonPayable: We have received your claim documents. As per documents available, patient was admitted in hospital with the complaints of LEFT CEREBELLAR TUBERCULOMA WITH LEPTOMENINGEAL ENHANCEMENT IN LEFT PARASAGITTAL, FRONTOPARIETAL REGION. Patient was admitted admitted for evaluation purpose only without active line of treatment. Hence, this claim stands repudiation under clause 4.4.11.

    Clause 4.4.11:- Diagnostic, X-Ray or Laboratory examination not consistent with or incidental to the diagnosis of positive existence and treatment of any ailment, sickness or injury, for which confinement is required at a Hospital/Nursing Home. LEFT CEREBELLAR TUBERCULOMA WITH LEPTOMENINGEAL ENHANCEMENT IN LEFT PARASAGITTAL, FRONTOPARIETAL REGION
    Cheque No./ Amount No Cheque Number / 0
    Deduction: NA,
    Despatch Date/Courier Name (Latest Despatch Details)

  2. #2
    umesh s chauhan Guest

    Default

    I am insured (mediclaim ) with New India Assurance Co. Ltd. Pol. No. 221500/34/10/11/00005980 . Put a claim for Rs. 18862/- on 14.9.11 with Vipul Medicorp TPA pvt. ltd. But till the date neither recd. claim nor any information.

  3. #3
    mintu.kgp@gmail.com is offline Junior Member
    Join Date
    Jan 2012
    Posts
    1

    Default Non receipt of claim for Health Check Up

    Dear Sir,


    Policy No 51260234100100200091 fvg P Roychowdhury & others


    I had submitted a bill for Rs 2760/-(Rupees two thousand seven hundred sixty only)
    Kharagpur Branch Office on 23.10.11. It is very unfortunate to me that you have neither paid the bill nor
    rejected the same. On enquiry with the Branch Manager from time to time it is learnt that the same has
    been sanctioned for payment but still on date no fruitful result yielded. If this is the standard of your
    service to the customers then I have to reconsider for renewal of the said policy with you. As such we cannot
    trust your organisation any more.

    Yours Sincerely

    Prasanta Roychowdhury
    Kharagpur.

  4. #4
    jitendra pal Guest

    Default Medicalim complaint

    I am insured under mediclam insurance policy of HDFC EGRO Genral Insurance.
    I was hospitalised from 05/06/2012 to 11/06/2012 whose documents for claim settlement were submitted in the office of haydrabad. After talking to them many times and even going personally several times, i am not getting any responsible answer from there. Every time I am told that your claim will be settled shortly.But after some time they have reject my claim. it's say is not cover my poslice in 1 st year but same condication other company is cover pokice in 1 st year so pls help me sir.

    Insured Na jitendra pal

    Policy no,(ref no.) HN07072011000534


    my total calim amount is 32000 Rs.

  5. #5
    PRINCE CHOPRA Guest

    Default Complain against new india assurance

    DEAR SIR/MAM

    My concern is that my mother was admited in surya hospital kanti nagar date 12-09-2012 to 15-09-2012, I had paid the bill amount 31155 rs deduction amount is 17624 rs, my insurence is continoue last 10-12 years in new india insurance company and my insured under policy no is 32030334120100000199 patient name is kailash rani age 75 years old. I am not satisfied with this amount and this is not fair with my old parents too. My home address is b-13, south anarkali delhi-51. Kindly help me and do the best for me as soon as possible.

    Thanks
    PRINCE CHOPRA
    9711192237

  6. #6
    rajesh19.mody@gmail.com Guest

    Default Claim amount of rs 1,10,000=00 still not received.-payment urgently require

    Dear Sir

    IC Name The New India Assurance comany Ltd.
    Claim ID MD11448625
    MDindia ID MD15-000497424
    pOLICY NO.111900/34/11/01/00006507
    Claim type :Non cash less
    Insured name Mr.Vinaychandra Domadia
    lODGE AMT :rS 118072=00
    Settled amt:Rs.1,10,000=00

    Dear Sir,
    We are sorry to inform you that ,although claim amt is settled ,still we have not received the amt from
    MDINDIA HEALTHCARE SERVICES (TPA) P. LTD.We are following vigorously for the claim amt,since the insured
    person is retired man & he donot have any source for the income.Although after follow ups with your TPA they
    are every time informing it will take 10 days.but,this type of reply we are hearing from last 1 month.
    Kindly send us the claimed amt by ECS immediately.
    Thanks in advance.
    From: Mr. Vinaychandra Domadia

  7. #7
    vijay kumar thethwar Guest

    Default Complaint for mediclaim payment not made by the new india assu. Com.

    मैं तथा मेरी पत्नी शारदा दी न्यू इंडिया एश्युरेंस कं में मेडी क्लेम के सदस्य हैं मेरी पत्नी के इलाज में हास्पिटल में हुए खर्च की मेडी क्लेम बिल पूर्ण औपचारिकताओं के साथ दिनांक १३.०९.१३ को मदीना भवन, कचहरी चौक ,रायपुर, छत्तीसगढ़ की कार्यालय में जमा कर दिया था किन्तु एक माह बाद भी दावा भुगतान नहीं हुआ है और ना ही दावा बेवजह लंबित रखने का कोई कारण बताया गया है, कम्पनी की सिटिजन चार्टर में मेडी क्लेम दावा भुगतान के लिए अधिकतम समय सीमा ३ दिन है, आपके कार्यालय में दावा अकारण रोका जाता है नियत समय सीमा के भीतर उसका निपटारा नहीं किया जाता है ,मैं तीन बार आपके कार्यालय जा चूका हूँ , कोई भी संतोस्जंक जवाब नहीं देता है , अतः निवेदन है की शीघ्र दावा भुगतान कराई जावे तथा यदि कोई कमी है तो बताई जावे तथा भविष्य में कंपनी की सिटिजन चार्टर की समय सीमा का सख्ती से पालन सुनिश्चित करने के लिए निर्देश दिया जाना चाहिए ताकि आपके कार्यालय में व्याप्त भ्रष्टाचार, लेटलतीफी तथा रिश्वतखोरी पर अंकुश लगे.

  8. #8
    Unregistered Guest

    Default new india assurance violationg claim

    hi,

    My father was admitted to a government hospital (R.G. KAR MEDICAL COLLEGE AND HOSPITAL)and as per the documents , i have provided all except the hospital registration number. This is because that hospital didn't have the rule to provide the same and as a result my claim was rejected. Do i have the option to move to the consumer court with all the available documents.? This is not a PRIVATE hospital , it's an old WEST BENGAL GOVERNMENT HOSPITAL and is quite renowned in west bengal. for private hospitals i can understand a registraion number is mandatory but for goverment hospitals i don't believe this is so much important.

    Please help.

    Thanks.

  9. #9
    Unregistered Guest

    Default Oriental Insurance & Raksha TPA not settling mediclaim

    Dear Sir/Madam,

    This is a complaint against Oriental Insurance and Raksha TPA Private Limited. I have a mediclaim policy from Oriental Insurance (Policy No:131300/48/2014/8321) bought from Oriental Insurance and Raksha TPA Private Limited which was recommended by Medimanage in Mumbai. I had submitted two claims after my hospitalization for Dengue and DVT subsequently. On March 13, 2014 Raksha TPA informed me by mail that both the claims under policy no 131300/48/2014/8321 are pass for Rs.342448/- & Rs.35329/- & payment will be done shortly. However, the payment never showed up and on March 28, 2014 Raksha TPA mailed me again this time informing me that one of the claims were non-payable and the other one was under query. Its been more than 4 months I have submitted these claims and till date neither Raksha TPA nor Oriental Insurance or Medimanage has managed to settle these claims and make the payment. I have submitted every corresponding documents as per the TPA requirements but no payment has been made even after promising to do so by the Raksha TPA.

    Sir, I request to take stern action against all responsible entities in this matter and seek us justice.


    Complainant Information
    ----------------------------
    Name: Rahul Ingle
    Location: Mumbai

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