Slno | ClaimNo | Auth. Date | ClaimType | PolicyNo | Cardno | InsuredName | PolicyHolderName | HospitalName | DateOfAdmission | DateOfDischarge | CaslessRequestAmount | CashlessGrantAmount | ClaimedAmt | FinalDisallowedAmt | ApprovedAmt | SumInsured(SI) | BalanceSI | ClaimStatus | Remarks | Deduction Reason | Chequeno | ChequeAmount | Chequedate | Awb. No. | DispatchDate |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | UN-3-143160 | CASHLESS | 021200/48/11/20/00000547 | AHUN0300643135 | VIMLA | SANJAY JAIN | MITTAL HOSPITAL AND RESEARCH CENTRE | 31/07/2011 | 31/07/2011 | 100000 | 0 | 0 | 0 | 0 | 110000 | 110000 | Query Raised For Cashless Authorization |
The M. D.,
Alankit,
Pl. note that I am the husband of agent of above policyholder and also relative of policy holder. Agent is attending to serious ill mother in ICU hence I am doing this correspondence.
With reference to above this is to state that ur site as above shows patient discharged. However patient is still in hospital.
1.Pl. inform how did you get this false info that patient is discharged.
2. Being service organization normally TPA's should come under RTI. Pl. clarify.
3. Your site says: Query Raised For Cashless Authorization. Pl. inform what query has been raised?
4. Why the query is not uploaded on ur site with other above details?
5. You have asked for 10 years policy copies from hospital. Is hospital suppose to possess such copies??
6.Is policy holder suppose to possess such copies / records of 10 years?
7. Does 10 years copies mean you want bribe of Rs. 10000/- to clear cashless?
8.Is it true to get TPA license your company has bribed to Chairman IRDA 10 crore ??
9.Is it true that insures pay you higher fees for delaying / harassing/ refusing claims.
10. Is it true that when u ask for details from insurers they ask bribe from you so you insist info from hospitals who do not have such info and can not have such info. And finally after under hand dealing you approve cashless and the effect is that that hospitals are left with no choice but to overcharge, follow unethical means to recover bribe paid to you ( and u paid bribe to IRDA for TPA license like we see in case of spectrum licenece and all other posts by eagles and appointed by eagles/ Govt ).
Pl. reply to all queries one by one as matter is going to go to consumer court.
CC to others : In one line while the senior citizen was on death bed ( ICU in bad condition) instead of TPA / Insurers harassed for 3 days asking for policy copy of 10 years fronm hospital and in turn hospital asking from patients relative. If I describe the whole episode of harassment meted out then may be some of u will have tears in ur eyes. But that is a sorry state of India contollede by bureaucrats. That is why we want LOKPAL BILL OF ANNAJI. And imagine where claimanet is senior citizen, paying 12500/- p.a. for over a decade for a policy of just Rs. 1 lac and they are made to run pillar to post.
And if I go to Ombudsman, or to consumer court or anywhere all r seated there thru back door/ corrupt practices , influence, caste system etc so no one will listen to me and I will waste my life in stinking corridors of these officers.
Hence I do not have any faith and hope in our system,.
Will some international body intervene. Can UNO put pressure on India to humanize its brutal system headed by lusty bureaucrats??
--
Thanks and Regards,
Alok Tholiya,
Jagruti Desai ✆
ReplyDelete17/12/2003
to me, Activist, Activist
i am an eye surgeon and i have faced similar problems when my mother was in and out of icu's for 6 months . all the problems you have listed are commonplace.
i think the problem is systemic. big hospitals' administrations are not answerable to anybody, the medical council is defunct , the insurance co.s are making losses and try to avoid settling claims, the IRDA seems to be ineffective, the TPA's have been introduced without due diligence.
i would still like to defend the dr.s . most dr.s are honest and try to do the best within the constraints of the system . but the patients need to become aware of where the problems lie . with the best will in the world we cannot improve all the systems on our own.
NGO's like yours are doing a good job trying to identify the problems and creating awareness.
dr. jagruti desai