Location/place: Kanpur
Name of company/service: Oriental Insurance Co. Ltd. & TPA, M/S Emeditek.
Sub. : Harassment in availing Cashless Medical Treatment.
Ref. : Policy No. 222200/48/2013/319 issued by M/S Oriental Insurance Co. Ltd., Kanpur
TPA : M/S Emeditek.
ID card No. : 10807120000163B
Name of the Policy/Card Holder : Ashok Kumar Bakshi.
PAC no. : EMSL/PAC/OICL/28748/2012 dated 16.08.12
Claim No. : 108081200064
Dear Sir,
It is a matter of great concern that I had obtained a Cashless Medical Insurance policy No. 222200/48/2013/319 from M/S Oriental Insurance Co. Ltd., Kanpur
For getting medical treatment,I submitted my ID card no. 10807120000163B ( Issued by the TPA i.e M/S Emeditek) on dated 14.08.12 to M/S Navyug Nursing Home & the nursing home intimated about my case to the TPA on the same day i.e 14.08.12 regarding my hospitalization etc..The required medical treatment was also started by the Nursing Home immediately. They specifically intimated to the TPA that the treatment is under Cashless facility as per policy etc.
The TPA did not respond within reasonable time however treatment was provided to me in urgent circumstances.
On dated 16.08.12 ,M/S Emeditek.( TPA) confirmed by mail that Pre-approval amounting to Rs. 22,000.00 has been approved against the estimated amount of Rs. 32,300.00.
Now, M/S Emeditek (TPA) are not honoring the claim submitted by the hospital with the remarks that patient already discharged. Whereas on dated 16.08.12, concerned Nursing home sent the claim to the TPA at 5.30 PM & I was discharged from the Nursing Home late in the night at 9.30PM ( on dated 16.08.12).
The TPA has directed to submit the claim bill at my end whereas is covered under Cashless Medical facility.
M/S Oriental Insurance Company Ltd. also sent mails to the TPA to honour the claim but so far there is no response from M/S Emeditek’s side .
Under the above circumstances, there is no other alternative to approach your good office to take appropriate action so that legitimate claim is settled without any further delay.
Ashok Kumar Bakshi
Kanpur
(M) 099358-18000
Leave a Reply