Mediclaim

Location/place: Lucknow

Name of company/service: United India Insurance co

I am employee of a big multinational paint company and am covered under group insurance scheme. I have been following up with the insurance company for my folloiwng dues since long but no action has been taken till date. Should I go in for litigation for the necessary compensation. The correspondence is as under :-

Dear Vanashree,

I requested you to forward the mail to the Divisional Manager of United India Insurance Co, who, I believe, is the final authority to take the decision and decide the issue, Ms. Roshni ji has already done me a lot of favours by giving me maximum benefit against my mediclaims, according to her earlier mail within her capacity after deducting Rs.16447/-From FIR No 2035283, Rs.546/- from FIR 2022719, Rs.2270/- from FIR 2011607 (which too was first rejected) and also by entirely rejecting FIR No 1995430 (for which an emergency certificate was also submitted ) for Rs.21479/- and FIR No 1678796 for Rs.23472/- which was in continuation to the treatment while the other bill of Rs.20352/-prior to this one was settled, by chq no 301137 dt 12.10.2009. Dr CG Agarwal’s prescriptions may please be referred to advising hospitalization.

Please note that Dr Khare of Shekhar Hospital clearly referred my wife Ranjana to SGPGI at about 2 pm as stated in his statement (attached), but being engaged in fulfilling the formalities like sending of bills, reports, prescriptions, etc from Shekhar Hospital for getting approval from Paramount, I was detained in the shekhar hospital only till late evening and even after sending all the documents, approval was not given but the initial amount of Rs.10000/- was also withdrawn by Paramount at the last moment when I was banking upon the cashless facility of the Insurance company and waiting for approval. Then I had to run from pillar to post for arrangement of funds in the evening only of that day as the Shekhar Hosp was not ready to discharge my wife till the final settlement of bill which I had to pay at last.

Then I could reach SGPGI around 7 pm and after a lot of struggle and tapping contacts by her sister she could be allowed admission and then doctors started investigations. Thus the delay of 4-5 hours in reaching SGPGI worsened her condition to such an extent that Dr was not ready to start treatment until they took a written statement from me which is also attached.

The delay in settling the bills and rejecting two bills and approval have been the main causes responsible for worsening her condition. All the bills were getting rejected only two bills were cleared and that too got very late and after deducting a huge amount from every bill including last bill of Rs.70k from which only 16 k was deducted, and now I have no hesitation in demanding a compensation of Rs.2 crore, which is, of course not going to help me restore my mental pease, happiness caused by the above way of harassment, nor can it return my wife and value of her life to me and my family. The untimely death of my wife has made our life a hell and has also affected badly my son’s future. So just to teach the Insurance Company and its third party administrator Paramount, compensation if must besides settlement of 2 pending claims and refund of deductions done in all the three bills.

I would also demand the persons handling these claims recommending deductions which were genuine and should have been paid, to be punished with imprisonment to set an example so that others may not suffer as I did .

Accoridng to policy, ambulance charges, gluco strips (prescribed by doctor) and any thing else which is a part of treatment and prescribed by the doctor is payable but these expenses have also been deducted. Investigations which were required and were part of treatment, a huge amount on this account has also been deducted.

I would also request our company’s intervention in this respect and highlight the issue to IRSD and media in case of further denial in clearing my claims as mentioned above.and let me know the status and action taken by the Insurance Company as I am not going to sit silent and will definitely take further legal action in case of non settlement of my dues alongwith the compensation amount of Rs.2 Crores.

Regards,
Vishal Singh Bartaria
AO – Lucknow
Mobile No. 9198571446
Landline No.05223016430

Vanashree Vaidya/AP-India/APL
07/13/2012 07:19 PM

To
[email protected]
cc
Vishal Singh Bartaria/AP-India/APL@APL, [email protected]
Subject
Fw: reply for your quarry

Dear Roshni Mam

Please let us know to whom shall we forward the request in United India Insurance.
to escalate this matter.

Regards
Vanashree Vaidya
Corporate Finance
022-39818422
—– Forwarded by Vanashree Vaidya/AP-India/APL on 13-07-12 07:13 PM —–

From: Vishal Singh Bartaria/AP-India/APL
To: Vanashree Vaidya/AP-India/APL@APL
Date: 13-07-12 04:45 PM
Subject: Fw: reply for your quarry

Please arrange to forward this mail to the Divisional Manager of United India Insurance Co also for further action at the earliest as I am under heavy debt and have to repay the same.

If desired I can send copy of all the prescriptions of Dr CG Agarwal who has advised hospitalisation when ever required and also use of glucostrips

Regards,
Vishal Singh Bartaria
AO – Lucknow
Mobile No. 9198571446
Landline No.05223016430

—– Forwarded by Vishal Singh Bartaria/AP-India/APL on 07/13/2012 04:33 PM —–
Vishal Singh Bartaria/AP-India/APL
07/12/2012 05:54 PM

To
Mahadevan Iyer/AP-India/APL, Pratap Kudva/AP-India/APL, Vanashree Vaidya/AP-India/APL
cc
“Ms. Roshni Ganjawala” “Shagufta Shaikh” , [email protected], “Gunjan Swarup” , Rajat Katyal/AP-India/APL@APL
Subject
Fw: reply for your quarry

Please find attached herewith a note received from Shekher Hospital explaining the necessity of investigations. I hope this will convinse you all and you will be kind enough to pay all the deductions done in the last bill i.e. 16k app as well as in other bills Rs.2200/- app.

Also please arrange to clear the bill (Ref no 1995430 for Rs.21470/-) for which Emergency certificate has already been sent to you. As regards Glucostrips please refer to all the prescription of Dr CG Agarwal where in he has always advised to monitor sugar with gluco strips.

Regards,
Vishal Singh Bartaria
AO – Lucknow
Mobile No. 9198571446
Landline No.05223016430

—– Forwarded by Vishal Singh Bartaria/AP-India/APL on 07/12/2012 05:39 PM —–
Shekhar Hospital
07/12/2012 04:31 PM

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[email protected]
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Subject
reply for your quarry

shekher hospital pvt.ltd.
lucknow

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