I have a reliance health policy and this is the 4th year. This year my wife who is also insured under the policy had to get admitted for a cholelithisis operation at a network hospital. Our TPA said that the Hospital needs to forward a form with certain documents for availing cashless benefit. The same was sent by the Network Hospital which later on the TPA said that they have not received. I had to then personally fax all the documents. The TPA then sent a query to the Hospital which again the hospital said that they did not receive. The TPA then sent me the query through mail which I submitted to the Hospital. I have found that the Network hospital and the TPA did not want to communicate with each other directly thereby making me a mediator for all their correspondances. As I have opted for cashless benefit, I am being bound to carry out their work as I need to get discharged soon. Also I spoke with a Reliance Executive connected with Health Insurance who put the entire blame on me saying I should have contacted him first and then the TPA. Could you please suggest me as to what should be my next step as TPA and network hospital are not communicating with each other even once.
Re: Health Insurance
by Ramdas Nayak on Aug 31, 2010 10:21 AM
A few years back it was more organised as there was only insurance company and insured. Now there is onle more in the middle to take your care. But the truth is your life becomes miserable as our calls land up with call centres where the customer care people behave more like a machine than humanbeing. Insurance Company keeps mum when complained about the lethargy in settlement. They think they should not have any direct approach with the insured forgetting that actually insured had insured for his health only with the former.
Re: Health Insurance
by srinivasan mv on Aug 31, 2010 10:43 AM
Generally, good hospitals have a corporate department who will handle the cashless claims. I see the fault with your hospital who have made you run around when your wife is not well. As suggested, before you get anyone admitted to hospital, inform the insurance company in writing (either by email or letter) and get them to acknowledge with their reference number. Submit to your hospital all documents required and ask them to get the cash less benefit.
Alternatively, if the amount is bearable, you can pay the amount out of your pocket and lodge your claim. You save the service tax of 10% plus surcharge.
Most likely that ur policy / CGHS/employers' scheme cannot come to ur rescue when needed--for the C.Hospitals/money machines say nil vacancy to even admit in ICU!! My just now experience
COMPANIES MUST ENSURE ABOUT PRE EXISTING DISEASE BEFORE ISSUING OF POLICY BUT IF ONCE ISSUE THEN THEIR SHOULD BE NO GROUND TO REFUSE ANY CLAIM ON PREXISING BASIS
Lets be pragmatic here. Even though we would opt for mediclaim and pay our premiums on time, what stops these companies to refuse payment for our case, on some ground or another? Mediclaim in India is a mirage and needs to be regulated by the Government. Private Insurance firms need to be accountable.
