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MPUH - TPA Covered Network Hospital is Denying to provide Cashless Facility

Complain ID : CCN016293   59   Complaint's Reply

Hospital Complaint Complaint Date: March 4, 2016
  • State :  Gujarat
  • City :  Nadiad
  • Address: Dr. Virendra Desai Road, Nadiad
Hello,

My Apollo Corporate Member ID is 10004516613.
My name is Hardik Shah working in SNL Financial company, Ahmedabad and my wife's name is Hemali Shah who is covered under Apollo's family medical insurance plan.

I am writing this mail with regards to my wife's Laparoscopic operation which I am planning to have in Muljibhai Patel Urological Hospital (MPUH) located at Nadiad in Gujarat. We have consulted Dr. Mahesh Desai for the same and have taken an appointment to admit in the hospital on 13th March, 2016. So, they will operate on 14th March, 2016 and so on with regards to Percutaneous nephrolithotomy (PCNL) operation and Laparoscopic surgery afterwards.

Now, MPUH is covered under Apollo's TPA (FHPL) network hospital list as available on the site. Due to network covered hospital we shall have cashless facility available at this hospital. I request the hospital to go for cashless for my wife's treatment, but the hospital staff and administrative department refused to provide cashless facility by providing useless reason that they have many medical claims pending with insurance companies as of now and so they will not provide cashless facility in current March month. Also, they said if we want to have cashless facility then they will provide in April month on wards only.

My wife has serious health issues currently and so this operation needs to be done at the earliest. But I don't understand how the hospital can just refuse to go for cashless facility. And what is the benefit of having corporate insurance policy with Apollo if their network hospitals are not providing the said facility at the required time. If I would have enough money to get the operation done on my own then why would I insured my family with insurance company by paying handsome premium amount, as they are worthless at the required moment.

What shall I do here as I don't have enough cash to pay the whole operation expense and your covered network hospital is denying to provide cashless facility.

I request you guys to contact MPUH at the earliest and get me avail the cashless facility as they are giving completely rubbish reason.

Kindly get back to me as soon as possible so I can take appropriate actions further.

Thank you.

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    by Apollo Munich Health Insurance:

    (4 of 5)

    Dear Mr. Shah, cashless facility can be availed at Muljibhai Patel Urological Hospital (MPUH). we have shared the details with you on 3/10/2016. please write to us at grievance@apollomunichinsurance.com for any pending issues.
    Regards, Grievance Management team

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