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Mediclaim Rejected

Complaint Rating:  100 % with 1 votes
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Contact information:
1. Claim ID: 115812/1
2. UHID NO: 82161
3. Patient Name: Pallav Choksey
4. Claim Date: 23 Apr 2011
5. Hospital Name: Shalby Hospitals, Ahmedabad, Gujarat
6. Organization Name: Idea Cellular Limited, Ahmedabad, Gujarat

I, Pallav Ashvin Choksey, went for a medical check-up to Shalby Hospital with pre-permitted appointment from my office (Idea Cellular Ltd, Ahmedabad, Gujarat).

My report was done on 09-04-2011 which I collected on 13-04-2011 from Shalby Hospital, shows that my diabetes was

1. Fasting 254, Urine : Present (++++) &
2. PPBS- 425, Urine : Present (++++).

I was been advised to get admitted for uncontrollable diabetes. I got admitted in Shalby hospital on 15.04.2011 under the supervision of Dr. Falguni Iyer and was on Insulin as well as oral dosage for diabetes control.

My claim got rejected with the reason that my diabetes was showing 4+ as per the report on 09.04.2011 and I got admitted on 15.04.2011.

Now can you tell me that without any treatment can the diabetes get lower within 5 days automatically that my claim got rejected with that reason? No one had advised me - Neither your mediclaim agent nor the doctor of your tie-up hospital that if I want to get admitted then within how many days I should take the action? Does Insurance Company want the patient to dream for such terms and conditions.

The other reason given to me was that in 4+ diabetes Oral dosage could have worked and that I was been advised wrongly to get admitted. Can I know that the hospitals which you have selected has such doctors who given wrong advices or if the advice is right than treatment given is wrong or if advice and treatment is right then should patient get admitted himself at his own home and should take insulin on his own and get the reports on his own, which a hospital does? This is what your insurance company doctors think or say?

Even after giving proper justification from the doctor in written thrice who has treated me, your doctors are not convinced to pass the claim because they see my case to reject only. Your doctor has neither called up Shalby doctor who has treated me and tried to understand the exact situation under which I was been admitted, so on what basis my claim was rejected.

I need a positive resolution from FHPL to restrict myself to knock the doors of consumer court to present them the dadagiri of insurance companies. My claim has all the valid reasons to get admitted and then to pass the claim.

Reports of 09-04-2011 (Fasting, PPBS & Glucose)
HBA1c report of 15-04-2011
Doctor's letter to justify the admission

Pallav Ashvin Choksey
+91 9824004285/+91 9624004285
Complaint comments Comments Complaint country India Complaint category Health & Life Insurance
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 1st of Oct, 2015 by    0 Votes
Dell - Internal Use - Confidential
UHID No NIC.12785101
Query Raised by FHPL:
Provide Prescription and Report Dated 09/07

I have already submitted all docs, the prescription in question is already mentioned in the Doctors’ prescription Booklet may be on the second or third page of Sitaram Bhartiya Hospital (Dr J Maheshwari).
In case you couldn’t find it, please arrange a call back taking that booklet and I would be able to explain it over phone.

After submitting my documents for claim, I received only one email for acknowledgement and none after it.
Tried to inquire it over phone however they say that we have sent you email, but I haven’t received it yet, please correct my email address as nishant_rastogi@dell.com and contact: 9871593999
Now its almost more than a month with no progress at all and I am highly disappointed that nobody from your team takes proactive action to close it. I do not understand that during the hospitalization time, I did not received any kind of problem then why are you not trying to help me now?

I have called twice on the toll free number and everytime I am asked to call back again to explain due to some or the other reason, I am just getting sick chasing your team and dialing the IVR again and again. Following is the concern I have raised today with Sathima over phone and she raised my concern with following Doc ID and promised to arrange a call back on Saturday after 11AM.
Raised Following Concern:
Document ID: 623057

Once you verify my medical documents, I would request you to kindly return it back to me for my future case history of this major operation and keep a copy with you.

Please let me know if all the above mentioned is clear, if not please get in touch with me at +91 9871593999 or please drop me an email at nishant_rastogi@dell.com and cc to rastogi.nish@gmail.com with an adequate contact number and I would surely call you to close this up asap.

Nishant Rastogi

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