Reimbusement of medical bills
Complain ID : CCN019981 34
Insurance Complaint
Complaint Date: June 13, 2016
Modified date: June 13, 2016
- State : Uttar Pradesh
- City : Ghaziabad
- Address: A-48/G-3, Shalimar Garden Main
I have a health insurance policy from HDFC ergo 2952200895207601000 since November 2013. I had admitted in the hospital Get well soon situated in shalimar gaden, ghaziabad from 28-2-2016 to 2-3-2016. this hospital is non network hospital which is nearest to my residence. After discharge from the hospital, I had registered a claim for reimbursement to HDFC Ergo with ref no. CCN No : RR-HS15-10340094. I had submitted all original documents with claim form to HDFC ergo. They had sent query indoor papers after registration the claim. I had fulfilled their query immediately with all original documents those provided by hospital. After some time they had sent another query related to bills and documents those already provided by me after discharge from hospital. Now I had replied to them by E-mail approximate 6 times and provide all the documents (as photocopy) again at least 3 times and also they had conversing with on phone with me. After this incident, They had sent a new query on 7 may 2016 and demanding new documents like -
Additional documents required:
Inadequate query reply received kindly provide - 1. Complete and readable medicines purchase invoices for all the medicines utilized during this hospitalization from the hospital/pharmacy shop bearing their batch no. with expiry date along with the Name, Address & contact number of the whole-seller/supplier on the Hospital letter head. 2.Authority letter on the official letter head of the hospital to verify the medicine purchase invoices from the distributor/supplier/manufacturer from which these medicines are purchased 3.Certificate from the treating Dr on his/her letter head with his/her sign and seal bearing his/her registration no. for details of S/S with duration, need for hospitalization, treatment given along with period of hospitalization & type of stay in the hospital also mentioning personal history of the insured and past treatment record if any along with his contact number and copy of registration certificate. 4.Certificate from the Pathologist on his/her letter head having conducted and examined the lab reports of the patient along with his/her sign and seal bearing his/her registration no. for confirmation along with contact details and copy of registration certificate. 5.Copy of general hospital tariff duly certified by hospital authority that includes Room Rent, ICU Charges, OT Charges, Visit and Nursing Charges. ,
I had go to the hospital and I had demanding all the documents from hospital. All the documents had provided by the hospital with in 2 days and I had sent all original documents to HDFC Ergo those provided by hospital and I I also kept photocopy with me. After that HDFC Ergo has denied and reject my claim on 23 may 2016 and they had information to me by mail as mention in this mail below.
I sent a mail to know that what is the reason to denied my claim on 24 may 2016 and also sent a reminder mail 25 may 2016. Now they had replied and also sent a letter to me as mention below. But they had not given a specific reason to me for this rejection.
Now I want to request to you please register a complaint against this rejection and do appropriate action against HDFC ergo.
Additional documents required:
Inadequate query reply received kindly provide - 1. Complete and readable medicines purchase invoices for all the medicines utilized during this hospitalization from the hospital/pharmacy shop bearing their batch no. with expiry date along with the Name, Address & contact number of the whole-seller/supplier on the Hospital letter head. 2.Authority letter on the official letter head of the hospital to verify the medicine purchase invoices from the distributor/supplier/manufacturer from which these medicines are purchased 3.Certificate from the treating Dr on his/her letter head with his/her sign and seal bearing his/her registration no. for details of S/S with duration, need for hospitalization, treatment given along with period of hospitalization & type of stay in the hospital also mentioning personal history of the insured and past treatment record if any along with his contact number and copy of registration certificate. 4.Certificate from the Pathologist on his/her letter head having conducted and examined the lab reports of the patient along with his/her sign and seal bearing his/her registration no. for confirmation along with contact details and copy of registration certificate. 5.Copy of general hospital tariff duly certified by hospital authority that includes Room Rent, ICU Charges, OT Charges, Visit and Nursing Charges. ,
I had go to the hospital and I had demanding all the documents from hospital. All the documents had provided by the hospital with in 2 days and I had sent all original documents to HDFC Ergo those provided by hospital and I I also kept photocopy with me. After that HDFC Ergo has denied and reject my claim on 23 may 2016 and they had information to me by mail as mention in this mail below.
I sent a mail to know that what is the reason to denied my claim on 24 may 2016 and also sent a reminder mail 25 may 2016. Now they had replied and also sent a letter to me as mention below. But they had not given a specific reason to me for this rejection.
Now I want to request to you please register a complaint against this rejection and do appropriate action against HDFC ergo.
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