icici health ins Complaints - approve and than disapprove

approve and than disapprove

Dear sirs, as you can see from the mails below, icici approved my clai amd than disapporved and now not willing to settle, need help can you help me resolve this claim.

Regards
mr. Raghvani

RE:'ICICILom=006-493-327' Health cashless claim refuse without any reason policynp.4034i/chc/0584272/00/000
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ICICI Lombard Health CareDear Sir/Madam, You are the valued customer of ICICI lombard. In response to ...
18 Jun

Reply |Walji Raghvani to a9879489180
show details 19 Jun

Dear sir,

If according the reason given for rejection of my claim is what you say, is than can you please give me the answers to my following questions before i pass this matter to lawyers.

a) Why was a prior approval given Re. 51550 alyhough the same papers were produced?

b) When the question of the difference of amount as per the hospital estimate of Re.135000 and your approval of 51550 was raised than only rejection came along?

c )Not only that but the hospital insisted on me depositing the difference of about Re.85000 betweem the amount approved and their estimate prior to my admission.

d) As i was to be admitted the next day and my policy refers as CASH LESS, i refused to pay and than phone calls started between me, hospital and your call center reps, who bluntly said this is a provisional approval and the rest will be settled when the final bill comes along. BUT NOT ONLY THAT BUT THE HOSPITAL SAID THESE ARE OUR TERMS OF ADMITANCE AND THEY DONT OBLIGE BY YOUR TERMS AND CONDITIONS. SO?

e) At approx 10.30pm. (night before my admition) i received a call saying my claim has been rejected and they wont honour any claims.

f) As arranged i went to hospital but they told me what your call center guys told me middle of night. So the matter stated getting hot and ultimately i had to write a hand letter which was gladly FAXED over to you, DO YOU AGREE WITH THE CONSECUENSES UPTO NOW, IF NOT PLEASE ADVISE.

g) So i had no option but to be opperated at other hospital, as i was in unbearable pain and it was getting worse, i am glad to say i have been opperated and felling better.

h) My last question is do you or any member of your staff KNOW that you all are carrying the same disablity as me BUT YOU ONLY NOTICE IT WHEN IT HURTS OR CANT BEAR THE PAIN, I MY CASE DUE TO FALL.
Further more when i went for medical check as per your recomendation, your rep should have noticed it, if it was pre existing.

Sir finally i am sorry to say, that you must exclude the word CASH LESS as you and your company are playing with words.

Regards,

Walji
- Show quoted text -
On 18 June 2010 17:52, ICICI Lombard Health Care wrote:
Dear Sir/Madam, You are the valued customer of ICICI lombard. In response to your mail dated 16/june/2010 pertaining to the authorization request status. We have analyzed the documents submitted by you. Please find the rejection reason. As per furnished documents, present ailment LBA with L5-S1 disc bulge and facet degenerative changes are CHRONIC in nature and PRE EXISTING cannot be excluded in this case. AS per policy terms, clause 3.1 of Part II Schedule, The claims arising on account of or in connection with any Pre-existing illness shall be excluded from the scope of cover under the policy. Regards,CustomerServiceICICIlombardhealthcare. -----Original Message-----
From: Walji Raghvani (wraghvani@gmail.com)
Date: Thursday, June 17, 2010 06:12 PM
To: ihealthcare@icicilombard.com (ihealthcare@icicilombard.com)
Subject: Health cashless claim refuse without any reason policynp.4034i/chc/0584272/00/000
Dear concern person With the refrance of given policy no. i am a existing client of your co. i have health cashless policy from your co. Before week i suffer from 1 injury and got admit in hospital after the lots of follow up i got approal letter from your side worth 51550/- than after i got a massge from hosptal your claim has been decline can you gi ve me the specify reason for my claim declain with the positivr support from you regards
--
Walji Raghvani
mo no:982547603

--
Walji Raghvani

Reply Forwarda987948980 is not available to chat

Walji Raghvani--
21 Jun

Walji Raghvania) Why was a prior approval given Re. 51550 although the same papers were pro...
21 Jun

Reply |ICICI Lombard Health Care to me
show details 22 Jun

Dear Sir/Madam,

You are the valued customer of ICICI lombard. In response to your mail dated 21/june/2010 pertaining to the authorization request status.

We are analyzing the documents and we will revert back you soon.

Regards,
CustomerService
ICICIlombardhealthcare.

-----Original Message-----
From: Walji Raghvani (wraghvani@gmail.com)

Date: Monday, June 21, 2010 11:14 AM
To: ihealthcare@icicilombard.com (ihealthcare@icicilombard