United India Insurance Company [UIIC] — claim not reimbursed

Address: 395009

GROUP MEDICAL SCHEME OF BANK RETIREES POLICY NO .[protected]P[protected] WITH DOMICILARY
RE. BOI ID 103423
DHS ID SE[protected]
MEDIASST ID[protected]
SUB. PARTIAL DECLINING OF CLAIM NO … 15414733 DATED 26/9/17
CLAIM AMOUNT - 1) CPAP OF CPEP MACHINE RS.72754 + COST OF TEST RS.5500/=78254/ AMOUNT NOT REIMBURSED
2) DOMICILIARY CLAIM AMOUNT RS.12219/
TOTAL CLAIM AMOUNT RS.90473/-
CLAIM AMOUNT SETTLED Rs. 12219/

After exhausting all sources, I am now approaching you with high hopes and as a last resort. Therefore, kindly spare few of your precious minutes from your busy schedule for me. There may be many retirees who must be suffering, suffocating slogging like me helplessly .
I am suffering from number of ailments SUCH AS DIMENTIA, ALZAMER, HIGH BLOOD PRESSRE, CHOLESTROL, SLEEP APNEA, DEPRESSION, HANDSHAKING .ETC.
I give below brief history of my grievances.
I, after few clinical/pathological tests prescribed by a Pulmonologist of Zainab Memorial Hospital –a trust run hospital for poor strongly advised by– DR. MADHVI GONDHA –MD, A PULMONOLOGIST TO USE CONTINUEOUSLY/ DAILY CPAP AUTOMATIC MACHINE FOR UNINTERPTED and ADEQUATE SUPPLY OF OXYGEN as there is FREQUENT BREAK DOWN OF BREATH . Consequently, ALL THE VITAL ORGANS OF THE BODY NAMELY BRAIN, MEMORY, EYES, LUNGS, LEVER, HEART, KIDNEY ETC..
You will please agree and appreciate that WITHOUT CONTINUOUS AND ADEQUATE SUPPLY of OXYGEN TO BODY, healthy survival cannot be imagined.
Upon doctors advice, cost of the CPAP machine was inquired. The cost was ranging between Rs. 65/90000.
I sent an e mail to DHS for pre authorization seeking permission to buy the CPAP machine. NO RSPONSE CAME FOR SOME DAYS.
The policy documents of Group Medical Scheme for retirees clause no 13.5 which reads as under “


QUOTE clause 13.5 of policy document of Group medial scheme for retirees of the bank.
“Rental Charges for External and or Durable Medical equipment of any kind used for diagnosis and or treatment including CPAP, CPAD, Bi-PAP, Infusion pump etc. will be covered under the scheme. However purchase of the above equipment to be subsequently used at home in exceptional cases on medical advice shall be covered " UNQUOTE

In view o[censored]rgency, I purchased a CPAP MACHINE relying on the terms and conditions of the policy document as stated herein above.

I submitted my claim for reimbursement of cost of CPAP MACHINE OF RS.72754/ AND AND PATHOLOGICAT/CLINACAL TESTS COSTING RS.5500/ amounting to Rs.78254/A-- ALONG WITH DOMICILARY CLAIM OF RS. 12219/ - on 26 th September 2017.
A query was raised by DHS on 3/10/2017 for submission CD OF BMI REPORT.
BMI is nothing but Body Mass Index which is an arithmetical calculation of Height and weight. The Pulmonologist certified that so long there is no CD made in India for BMI . The original certificate is with DHS. An email along with Zainab Memorial Hospital and doctor’s certificate, hospital case papers, BMI GRAPH and other papers were emailed on 6 th October and the hard copies thereof were couriered which have been received by DHS on 9th Octber 2017.
After trail of correspondence by me to DHS, when no response came I contacted the following authorities
[protected]@dhs-india.com
[protected]@dhs-india.com
[protected]@bankofindia.co.in
[protected]@dhs-india.com
[protected]@mediassistindia.com
[protected]@mediassistindia.com

Email addressed to the General Manager Shri M. K. Gupta were attended by Miss Binty Raut and help desk by Shri Neeraj Soni. Both were cooperative .They wrote to DHS . But as you must be aware that the DHS never replies to anyone.
Last fortnight I saw on web of Medibuddy the FINAL REMINDER- INFORMATION AWAITED.”
In fact the information /papers required were sent there and then on 6th October 2017 followed by hard copies received by DHS on 9thoctober 2017.
Last week it was displayed “MEDICINES ARE NOT RELATED WITH AILMENTS” . I sent an email to the authorities
[protected]@dhs-india.com
[protected]@dhs-india.com
[protected]@bankofindia.co.in
[protected]@dhs-india.com
6.[protected]@mediassistindia.com
7.the General Manager Shri M.K.Guptamrutanjay-mrutunjay.gupta @ bankofindia .co.in

The matter was under correspondence till yesterday.

At 5.30 P.M YESTERDAY I.E 22/11/17, It was displayed on Medi- buddy site -web that Rs . 12219/ - considered for my claim no 15414733 DATED 26/9/17 the DHS has considered only DOMICILARY claim of Rs 12 239/

NEITHER THERE IS ANY MENTION OF PART PAYMENT NOR MENTION OF REASON OF DECLINING CLAIM OF COST OF CPAP MACHINE AND CLINICAL/PATHOLOGOGICAL CHARGES. NOR GIVEN ANY COGENT REASON FOR NOTCONSIDERING
REIMBURSEMEN OF CPAP MACHINE ALTHOUGH THE POLICY DOCUMENT IS CRISTAL CLEAR.IIT MAY BE REITERATED THAT IT IS MACHINE AND NOT MEDICINES AS UNDERSTOOD /TREATED BY DHS MUMBAI.

MY AILMENT IS GENUINE, MY TREATMENT IS FROM REPUTED PULMONOLOGIST, NEED OF CPAP MACHINE IS UNAVOIDABLE AND TO TOP IT ALL IT IS WELL SPELT OUT IN THE POLICY DOCUMENT IN CLAUSE 13.5 AS STATED HEREIN ABOVE
I LOOK FORWARD TO YOU
Today morning while talking to H.o. I.R dept and help desk, I was informed there helplessness. . Hence this mail to you.
For the present I donot enclose copies of all the documents and e mails/ trailing correspondence, leave aside several telephonic talks with various authorities. However, If need be I will send a all the papers to you.ORIGINALS ARE LYING WITH DHS MUMBAI.

Sir, The DHS attitude and is certainly agonizing, humiliating and scarring to the senior citizens/retirees.
I with folded hand seek your whole hearted co operation and intervention for my genuine ailment, genuine claim.
With Regards.
K M DALAL
MOB [protected]