I have purchased a Health Saver policy (Policy Number 15042661) from ICICI prudential in the month of February 2011, for family floater coverage of INR 500000. The cost of the policy was INR 15000. Me (M 34), my wife (F 27) and my child (F 2) are covered under the policy.
My child got admitted at Manipal Hospital Bangalore on 29 Apr 2011 due to lower respiratory tract infection and breathing problem. ICICI prudential agreed for cashless hospitalization and approved INR 15000 as pre-auth amount. My child became alright by 01 May 2011 and was discharged. Since ICICI Prudential was not working on 01 May 2011, I had to make a payment of INR 18000 at hospital while discharging the child. Hospital gave all the required documents to go for a claim of the amount paid by me.
Later as instructed by the ICICI prudential customer care, all the required original documents were dispatched to their Navi Mumabi office on 07 May 2011 via Government of India Speed post EMS. The documents got delivered on 09 May 2011 at the office of ICICI Prudential. The customer care informed me that the claim would get processed and money would be debited to my account within 12 days. But it never happened.
I have been calling the customer care from 24 May 2011 onwards regularly to confirm the status of the claim. They have sent the pre-auth amount to the hospital and closed the case. The customer care could never guide me on the next action plan. They have been making promises that it would get processed in 2 days and they would call me back and inform the details. But promises remained promises. Till today my claim did not get processed. None from ICICI prudential did call me. Some of the customer care executives informed me that the case is already closed and nothing could be done.
I am sure – it may not be an isolated case. At the time of purchasing the policy the representative of the insurance company told so many sweet words about the facilities provided by the policy. But when it came to a claim they are trying to fool the customer. Many customers would be facing similar problems. I am ready to go even legal, not only for my right of claim but to inspire others to take similar actions and restrain the insurance providers from cheating the consumers. I need to know, how to go ahead.
Warm regards
Suresh Nair