Star Health And Allied Insurance — Denying cashless claim at network hospital

Address: Chennai, Tamil Nadu, 600 034

Website: www.starhealth.in

Denying cashless claim at network hospital!

Policy number : 161130/01/2017/000174 (Group mediclaim policy offered to staff from max health care ltd)
Coverage : rs2, 00, 000/-
Claim number : 0095975

This is regarding claim number 0095975 where the star health insurance is denying the additional amount towards cashless facility in rcc, trivandrum which is listed as network hospital.

Details:

The patient was admitted on 31-may-2017 in rcc trivandrum and on the same day an amount of rs25, 000/- was approved. The patient is still admitted and we had

Requested for enhancement/additional amount which is remaining in the policy as the approved amount was exhausted and started paying from hand. The documents were faxed multiple times to 1800 and star health claims that they have not received the documents. Again the documents were faxed on 24-june-2017 as per instructions from someone who spoke to me as an assistant team leader on 23-june-2017. He had promised that he will message me the email address to which i can send the documents but he did not do it. I had then sent an email to "[protected]@starhealth.in" on 23-june-2017 with details to which i have received the reply on 24-june-2017 stating that they are looking into it. On 24th june 2017, i spoke to someone and was given the email id "cashless. [protected]@starhealth.in" and forwarded the pre-authorisation form and the document transmission report to "cashless. [protected]@starhealth.in" and "[protected]@starhealth.in" and called them again. After multiple transferring the "concerned" departments, one lady was asking me to send the final bills to process the same. It sounded absolutely idiotic and irresponsible as we were not making a reimbursement claim post discharge but asking to approve amount towards cashless facility as the patient was never discharged after 31-may-2017. Then she asked to provide a self request letter from patient signed by the doctor from the hospital as she said they have only received the pre-authorization form. On asking how do you expect the patient who is admitted to sign and send the request letter, she had replied that she will check with the hospital and would return the call back (I am still waiting for her call!!!). We then contacted the hospital authorities to counter sign the letter and they were demanding the bills to get it signed from the doctor. We have explained them that we are not looking for reimbursement but to have the cashless facility to which they are not understanding. On contacting starhealth again, i was given a new email id - "cashless. [protected]@starhealth.in" and forwarded the documents - no update so far and i am delighted - wow!!!

The questions:

1) i have called multiple times to star health and had no resolution (Please see screenshots of calls made from 23rd june 2017 and the duration i was on call).
2) why are continuously telling that you have not received the documents faxed? I am attaching the pictures of document transmission report for your reference. Do you think the sender has any control on the electronic medium once the document is sent and he receives a confirmation that it has been transmitted successfully?
3) none of the emails to the emails ids you had given were bounced - so why are you telling lie that you have not received any emails? It is to be noted that

The lady who promised the call back has replied that only pre-authorisation form received and asked to send the self request for enhancing the limits. All
The emails were addressed to "[protected]@starhealth.in" as well. If you are saying that you have not received any emails, then how did you respond to my query? I am attaching screenshots to prove that you are telling lie that you have not received the e-mails? Is it that you are trained to tell us that you have not received the documents to deny/delay the claim?
4) if fax and emails are not successful mediums to deliver the documents to you, what is the the other option to send you the documents as we already know that your telephone executives are found useless? And how can someone ensure that you have received the documents or not? And if you are expecting bills to be submitted as documents other than pre-authorization form, please understand that we are not looking for reimbursement but cashless facility.

5) i have spent hours with your telephone executives and had no resolution. They are asking me who told you this (It is idiotic to ask this but they are doing it under the confidence that they can not be traced with just first name) and do whatever you want to do - we have not received the documents. I myself work with service industry and understand that there must be information tracked regarding customer interactions and they should be able retrieve history than letting customer explain each time to each executive and having no resolution and challenging the customer as to do whatever you want and disconnecting the calls is just arrogant and ignorant towards the customer especially when it is towards medical assistance.

So let us know what needs to be done that is within hospital procedures to have this request approved!

Gireesh kumar n n
[protected]