Complain for Insurance claim recovery case by FHPL at Saifee Hospital, Mumbai
Complain ID : CCN021455 19 Complaint's Reply
Corruption Complaint
Complaint Date: July 30, 2016
Modified date: July 30, 2016
- State : Maharashtra
- City : Mumbai
- Address: 1/306, Dheeraj Sagar Bldg, Link Road, Opp. Goregaon Spoort Club, Malad West, Mumbai 400064
I am Subhash Gadia , aged 58 years, had undergone a surgery on 24th May 2016 at Saifee Hospital, Mumbai, by a very senior Dr.Muffazal Lakdawala.
I am under insurance cover by FHPL but after surgery when I submitted all my medical documents as required by FHPL for remimbursement of claim amount Rs. 4,55,650., I was shocked to understand that my claim was rejected by FHPL for below reason.
Reason by FHPL for rejection:
"As per our medical opinion & the submitted documents, your claim was for morbid obesity,which is excluded from your health insurance Policy. Hence we regret to inform you that your claim is repudiated."
Where as this surgery is for METABOLIC SYNDROME as per Saifee Hospital & Dr. Muffazal Lakdawala. Dr. Lakdawala has also given a special Detailed Report for FHPL (which is attached in this email for your reference). This letter issued by Dr. lakdawala clearly mentioned that this surgery is not a cosmetic procedure for this patient but purely conducted to prevent further deterioration of my health.
Request you to take up the matter with FHPL and help me recover my claim and oblige me.
For your information, I am trying to upload images for Dr. Lakdawala and Saifee hospital and FHPL documents but the upload failed everytime, request you to please share your email id to send the same.
Contact number of FHPL: 1800-425-4075
My Contact details:
Subhash V. Gadia
Mob No: 9821611134 / 022-28443834
I am under insurance cover by FHPL but after surgery when I submitted all my medical documents as required by FHPL for remimbursement of claim amount Rs. 4,55,650., I was shocked to understand that my claim was rejected by FHPL for below reason.
Reason by FHPL for rejection:
"As per our medical opinion & the submitted documents, your claim was for morbid obesity,which is excluded from your health insurance Policy. Hence we regret to inform you that your claim is repudiated."
Where as this surgery is for METABOLIC SYNDROME as per Saifee Hospital & Dr. Muffazal Lakdawala. Dr. Lakdawala has also given a special Detailed Report for FHPL (which is attached in this email for your reference). This letter issued by Dr. lakdawala clearly mentioned that this surgery is not a cosmetic procedure for this patient but purely conducted to prevent further deterioration of my health.
Request you to take up the matter with FHPL and help me recover my claim and oblige me.
For your information, I am trying to upload images for Dr. Lakdawala and Saifee hospital and FHPL documents but the upload failed everytime, request you to please share your email id to send the same.
Contact number of FHPL: 1800-425-4075
My Contact details:
Subhash V. Gadia
Mob No: 9821611134 / 022-28443834
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fhpl Customer Service by fhpl:
(4 of 5)
Dear customer,
Please share your details with support team, we will resolve it at grievances@fhpl.net
For information call : 1-800-425-4033
Address : Srinilaya – Cyber Spazio Suite # 101,102,109 & 110, Ground Floor, Road No. 2, Banjara Hills, Hyderabad, 500 034.
FHPL is a Third Party Administrator in the field of Health Insurance duly licensed (Licence No. 013) by Insurance Regulatory Development Authority of India.
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