This is a discussion on TTK mediclaim reimbursement within the Medical Insurance forums, part of the Insurance category; Hi,I am working with Keane India ltd for last 6 years and company continues providing mediclaim policy from TTK healthcare ...
Hi,I am working with Keane India ltd for last 6 years and company continues providing mediclaim policy from TTK healthcare service ltd. They are providing us Cashless facility this is corporate policy. I would like to tell u My wife(Renu) is suffering pain in down abdomen (Belly) after the MRI with contrast suggested by Dr Sadhna found that she was suffered from Rasoli in Uterus and u have to treat it urgent because its size was increased continues. Dr. Sadhna is a gyno in Shri Balaji Action medical institute in Paschim vihar. Dr suggested us that for that disease we first do the D&C then after mirena insertion because ur wife is only 30 years old we cannot remove the uterus this could be possible only after 35 of age. Neither it will cause some genetic problem. So my wife(Renu) admitted on 22-06-2011 for first step in Shri Balaji Action medical. On that day I was send form for approval with all the diagnose suggested by dr. after 2-3 hours we got intial approval for Rs10000.00. But till the discharge we not got final approval they are sending query again & again till next day. Then I talked with Ms. Sadhna (09611805313). She was spokes person for keane India She said ok u discharge ur wife and pay the bills and when u will send the documents for reimbursement then would approved it. Again my wife was admitted for second step for mirena insertion on 30-6-2011 in the same hospital. Again same thing happened they again not replied anything for approval for the treatment. Then I again pay all the bills from my pocket discharged my wife next day. I submitted the document on 12-7-2011 for reimbursement for the both admitted days. After more than one month they replied that your claim was rejected because as per our thinking this is investigational on 22-06-2011 and we think and for 30-6-2011 claim was for infertility. Then I go to Dr. and get written document. In that document DR. written clearly that it was not investigational for 22-6-2011 & for 30-06-2011 claim not a case of infertility. Because she clear written. I have two children younger daughter is of 9 years and son is 4 years old. There is no chance of infertility. The total amount of claim was (22-06-2011 Rs20235.47 & for 30-6-2011 Rs13265) Rs33500.47. And my salary was not much that I can bear that shock. At very last month The ER spoc said to me that TTk said we don’t consider photocopy of physician written notes on hospital letter head, we require only original when after missing by ttk service provider. At present my moral was totally down. Plz do the require action the TTK healthcare service.