| Address: Pune, Maharashtra |
I am covered by a group health insurance scheme of M/s New India Assurance Co. Ltd., Chennai. Now I am suffering from Kidney failure and need to undergo Dialysis thrice every week since Feb. 09. I have been submitting hospital bills on a monthly basis and the insurance Co. have been reimbursing the amount spent. They deducted Rs. 12, 915/- from my claim for the month of July, ’10, on the grounds that some hospital bills supporting my claim did not provide details of material used for dialysis. I replied, stating firstly that they have been settling all my claims both previous to and subsequent to the claim for the month of July, ’10 where some supporting hospital bills may not give details of material used for dialysis but there was never any objection. If details of material used are necessary, then why did they not ask for these when settling my other claims? If these details are not required then why are they asking for them to settle this claim? Secondly, the 14 hospital bills for dialysis during July ’10, can be divided into two categories. Those where the total amount charged is Rs. 2,604/- and those where the total amount charged is Rs. 1412/-. One bill, totaling Rs. 2604/- has details of material used. Similarly, one bill totaling Rs. 1412/- has details. It is obvious that all other bills wherein the treating hospital is the same, patient is the same, the month when procedure was performed is the same, the process is the same & totals are the same, the material used will also be the same. So, details of material used for dialysis already with them, for all bills and thirdly, the treatment to be given and the material to be used for such treatment is entirely at the discretion of the treating doctors/hospital and any alteration there does not alter the liability of the health insurance Co. This was pointed out to them.
However, the insurance TPA refuse to pay the deducted amount. Was this information helpful? | 
The New India Assurance Company Ltd — non reimbursement of claim
This is to inform you that I hold a mediclaim policy against member ID N090798 in Raksha TPA (Policy No. 311701/34/10/11/[protected]. I was hospitalized in Government Medical College Hospital on 11 October 2010 till 22 October 2010 as a case of hip fracture treatment surgically in Chandigarh. The request for claim was duly submitted within 7 days from the date of hospitalization, but there was no response whatsoever.I have been following up with the TPA officials, but all in vain. The company officials made me come to the office, and did not help me with the matter. In addition, officials of Raksha TPA have stopped answering my calls. This is highly disappointing behavior from a company that is associated with a company of your stature in the country. I wonder that if I, being a senior citizen is not being assisted, how will be other cases be dealt by the company governed by you.
As claim amount stands at Rs.106429/- that amount is huge for me as a senior citizen. My income is solely on interest from my retirement saving. At the time of my hospitalization I had broken my fixed deposits to pay the hospital bills. I had submitted all bills on 27 October believing claim to be settled in 20 or 30 days time. Its 5 months now but I hadn’t received any claim from TPA.At this age my conscious doesn’t allow me to ask for money from my daughters who are married now. Raksha TPA have not settled any claim but given me depression from this entire scenario.
As a senior citizen I expect you listen my cry and also expect all kind of co-operations from your organization, and would request you to please look into the matter at the earliest possible. Let me know in case you require further details.
Thanking you,
Avtar Singh Sachdeva
B 13 C, MIG FLATS,
MAYA PURI,
NEW DELHI-110064
PH: [protected]