I am Dominic Manuel, a resident of Bangalore and I have a Happy Family Floater Policy with Policy No. 423100/48/2011/793. My wife was admitted to Colombia Asia Hospital on 11th of June and discharged on 12th of June. She was rushed to the hospital where she was treated at Emergency ward at 1:55 PM and she was kept there because there was no bed available till 6:33 PM. At around 5:38PM the hospital informed the availability of the bed and shifted her to the ward at 6:30 PM. There were some tests done on her between 5:38PM - 6:33 PM before they shifted to the ward. She was discharged on 12th June 2011 at 4:02 PM.
Since it was a medical emergency I had no time to take my insurance papers. Anyhow I payed the hospital expenses and later submitted my claims papers at TPA Raksha office in Bangalore on 20/6/11. They asked me to give a call a week later and when I called a week later, their response was sickening. They say the bills does not qualify for repayment because she is not admitted for 24 hours. It is the height of irresponsibility on your part to pass on claims on someone else rather than yourself. Secondly TPA Raksha people people have no courtesy to go through the papers in detail.
Bill No. OP - 838488 gives Adm date and time as 11/6/2011 1:55 PM
Bill No. OP - 838488 gives Dis date and time as 11/6/2011 5:28 PM
Bill No. IP-40277 gives ADM date and time as 11/6/11 6:33 PM
Bill No. 1P 40277 gives DIS date and time as 12/6/11 4: 02 PM
Just common sense is required to say the same patient was rushed to Emergency Ward and then shifted to ward. And nursery level mathematics says one has exceeded 24 hrs stay in a hospital. I have paid the premiums to this policy for over 15 years without any claims except once. You should know no one goes to the hospital unnecessarily and no one stays in the hospital unnessarily. Since my wife is also a medical doctor she was discharged early knowing she can take care of herself without further need for hospitalization.
TPA people are thugs. I don't understand why insurance companies put their clients under such pressure. While selling their products insurance companies do not even mention the possibility of non payment.
Review about: Insurance.