Complain with HealthIndia Insurance TPA Services Private Ltd., Alliance Insurance Brokers Pvt. Ltd.

Dear sir,

I want a solution as per insurance rule . Please tell me the procedure after reading following mail carefully.
The approved claim amount is not credited till now.

I also attached the hospital letter against the cause ie. Send to insurance company.

With regards
Siburam Gayen

From: Reshma Shaikh [mailto:reshma@allianceinsurance.in] Sent: Monday, July 02, 2018 5:42 PM To: 'Parvez Aslam' Cc: dhananjay@allianceinsurance.in Subject: RE: Submission of shortfall documents toward Jayasri San


Dear Sir,

Please find below the TPA’s revert on shortfall documents highlighted in yellow.

·         Rs.500/- deducted, Reason :Consultation Charges, No Proper Bill Receipt
·         Rs.1000/- deducted, Reason :Professional Charges, No Proper Bill Receipt
      Kindly provide proper number pre-printed cash receipt of Rs.500/- & Rs.1000/-. On receipt of this we will further look into the matter.

·         Rs.2100/- deducted, Reason :Anaesthesialogy Charges, Break Up Details Not Available
      As per clarification letter received towards anesthesia charges are of anesthesia machine & technician charges of Rs.2100/- are the part of operation theatre charges. Hence same is cannot be separately admissible.

·         Rs.16000/-deducted, Reason :Assistant Surgeon Charges, Dr Name Not Available
     As per clarification letter towards assistant surgeon charges are the group of doctor who are taking care during operative & post operative period, this clarification towards assistant surgeon is not for a single doctor fees which assist during surgery. Hence same is not acceptable.

Regards,
Reshma Shaikh
Mobile: +91 8433910631 |

  
Alliance Insurance Brokers Pvt. Ltd.
Corporate/ Registered Office: 8th Floor, Gold Crest, 10th Road, Juhu, Vile Parle (W), Mumbai 400 049
Composite Broker | Licence Code No. CB219/03 | Certificate No. 217
Licence Validity – 13/10/2015 to 12/10/2018| CIN - U67200MH2003PTC141621


Dear Sir,
 Please find below the claim authorization details of Mr. Siburam Gayen (Emp Id B0064).
 
Policy Number :
2802002817P101715019

Group Name :
M/S INOX AIR PRODUCTS PRIVATE LIMITED

Claim Number :
HI-UIC-000445796-0

Type of Claim :
Reimbursement

Date of Admission :
15-01-2018

Date of Discharge :
19-01-2018

Ailment :
TORSION OF RT OVARIAN MUCINOUS CYSTADENOMA, LEFT OVARIAN CYST

Patient Name :
Jayasri Santra Gayen

Hospital Name :
Apollo Womens Hospital

Hospital City :
Chennai

Employee Code :
B0064

Employee Name :
SIBURAM GAYEN

Authorization Amount :
Rs.128380/-

Details of deduction is as follow :
1.      [Rs.71/-] Reason :(Rs.71/-Betadine), Non Medical Items Deducted  2. [Rs.140/-] Reason :Disposable item Charges, Not payable.  3. [Rs.340/-] Reason :(Rs.340/-Gauze Ordinary), Non Medical Items Deducted  4. [Rs.500/-] Reason :Consultation Charges, No Proper Bill Receipt  5. [Rs.500/-] Reason :(Rs.500/- Sitz Bath Basin), Non Medical Items Deducted  6. [Rs.600/-] Reason :Medical Record Charges Not Payable
2.       7. [Rs.690/-] Reason :(Rs.240/-Controlled Pencil with Cautry Tip,Rs.50/-Pkt Sterile Pack,,Rs.400/-Gauze Lap Sponge ), Non Medical Items Deducted  8. [Rs.810/-] Reason :Recovery Room Charges, Not payable.  9. [Rs.1000/-] Reason :Professional Charges, No Proper Bill Receipt  10. [Rs.1000/-] Reason :Nutritional Charges not payable  11. [Rs.1050/-] Reason :(Rs.1050/-OT Handling Charges, Not payable  12. [Rs.2100/-] Reason :Anaesthesialogy Charges, Break Up Details Not Available  13. [Rs.3000/-] Reason :(Rs.3000/- Tour Travel not payable)  14. [Rs.8519/-] Reason :(8519/-Actico Thigh Length,Ahd Special,Ap Thermometer,Clohex Mouth Wash,Dc Under Pad,Face Mask,Gallant Disposable,Gloves Examination,Medicine Kit,Nurses Cap,Respirometer,Apron,Cd Site,Betadine,Dc Alcohol Swab,Dc Undar Pad,Dynafix,Ecg Electrode,Face Mask,General Linen,Gloves Examination,Gown Bundle,Oxygen Face Mask,Standerd Gown,Steri Strips,Surgeon Cap,Uma Urinary Catheter,Betadine Sol,Tegaderm With Absor), Non Medical Items Deducted  15. [Rs.16000/-] Reason :Assistant Surgeon Charges, Dr Name Not Available  

 
 
Regards,
Reshma Shaikh
Assistant Manager – Employee Benefits
Mobile: +91 8433910631
Alliance Insurance Brokers Pvt. Ltd.
Corporate/ Registered Office: 8th Floor, Gold Crest, 10th Road, Juhu, Vile Parle (W), Mumbai 400 049
Composite Broker | Licence Code No. CB219/03 | Certificate No. 217
Licence Validity – 13/10/2015 to 12/10/2018| CIN - U67200MH2003PTC141621

From: Siburam Gayen [mailto:siburam.gayen@inoxap.com] Sent: Sunday, July 08, 2018 1:09 AM To: 'reshma@allianceinsurance.in' Cc: 'dhananjay@allianceinsurance.in' Subject: RE: Submission of shortfall documents toward Jayasri Santra Gayen

Namaste sir/madam,

I want to inform you that I have already get reimbursement 3times from other insurance company. Your company is 4th time.
They never creates this type of issues. If you want to create this type of issues, please confirm with your company rule in respect of the session 2017-2018.  Not like this written excuse with out any clause. I think, you want to express me that I create these bills / documents fraudly with involving this type of reputed hospital with bypass their system. If so, please confirm to take information from hospital as they can take steps or improve their billing system.

Otherwise you confirm  steps for solving the problem.

Thanking you.
Siburam Gayen
MOB.-9470121435



From: Reshma Shaikh [mailto:reshma@allianceinsurance.in] Sent: Wednesday, July 18, 2018 5:12 PM To: 'Siburam Gayen' Cc: 'dhananjay@allianceinsurance.in' Subject: RE: Submission of shortfall documents toward Jayasri Santra Gayen

Dear Sir,

Please find revert highlighted in yellow.

Rs.16000/-deducted, Reason :Assistant Surgeon Charges, Dr Name Not Available – Approved.

Rs.1000/- deducted, Reason :Professional Charges, No Proper Bill Receipt – Under process for Approval.

Rs.500/- deducted, Reason :Consultation Charges, No Proper Bill Receipt – TPA required doctor’s consultation letter and doctor’s stamp on receipt for the processing of deducted amount (If required, we will request TPA to return us the bill so you can take doctor’s stamp on it.)

Rs.2100/- deducted, Reason :Anaesthesialogy Charges – Charges are of anesthesia machine & technician charges which is the part of operation theatre charges, hence Separately not payable.

Regards,
Reshma Shaikh
Mobile: +91 8433910631 |

  
Alliance Insurance Brokers Pvt. Ltd.
Corporate/ Registered Office: 8th Floor, Gold Crest, 10th Road, Juhu, Vile Parle (W), Mumbai 400 049
Composite Broker | Licence Code No. CB219/03 | Certificate No. 217
Licence Validity – 13/10/2015 to 12/10/2018| CIN - U67200MH2003PTC141621



From: info@healthindiatpa.com [mailto:info@healthindiatpa.com] Sent: Wednesday, July 18, 2018 1:29 PM To: parvez.aslam@inoxap.com; parvez.aslam@inoxap.com Subject: Claim Authorised for Patient : Jayasri Santra Gayen | CCN:HI-UIC-000445796-1

Dear Sir/Madam,
Greeting from Health India!!!
Your claim has authorised Rs.16000/-. The payment will be released through NEFT to the account number shared with us.
Claimant Details:
Policy Number :
2802002817P101715019

Group Name :
M/S INOX AIR PRODUCTS PRIVATE LIMITED

Claim Number :
HI-UIC-000445796-1

Type of Claim :
Deduction Payment

Date of Admission :
15-01-2018

Date of Discharge :
19-01-2018

Ailment :
TORSION OF RT OVARIAN MUCINOUS CYSTADENOMA, LEFT OVARIAN CYST

Patient Name :
Jayasri Santra Gayen

Hospital Name :
Apollo Womens Hospital

Hospital City :
Chennai

Employee Code :
B0064

Employee Name :
SIBURAM GAYEN

Authorization Amount :
Rs.16000/-

Note: This is a system generated e-mail, please do not reply to it.
Thanking you and assuring you of our best services always.
Regards,
HealthIndia Insurance TPA Services Private Ltd.
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From: Reshma Shaikh [mailto:reshma@allianceinsurance.in] Sent: Monday, August 20, 2018 11:59 AM To: 'Parvez Aslam' Cc: 'Dhananjay Kulkarni' ; 'Mediclaim' Subject: RE: Claim Authorised for Patient : Jayasri Santra Gayen | CCN:HI-UIC-000445796-1

Dear Sir,

This is with reference to the deducted amount pertaining to claim of Mr. SIBURAM GAYEN, TPA accepted to process the claim further for partial payment of deducted amount towards assistant doctor charges, but on audit of the claim insurance company would require the name & role of assistant doctor since as per attached letter provided by the hospital it mentions only ‘Group of Doctor’, as insurance company need clarification on name & role of doctor in this case as already main surgeon charges & nursing charges has been paid.

Regards,
Reshma Shaikh
Mobile: +91 8433910631 |

  
Alliance Insurance Brokers Pvt. Ltd.
Corporate/ Registered Office: 8th Floor, Gold Crest, 10th Road, Juhu, Vile Parle (W), Mumbai 400 049
Composite Broker | Licence Code No. CB219/03 | Certificate No. 217
Licence Validity – 13/10/2015 to 12/10/2018| CIN - U67200MH2003PTC141621