Cash less claim rejected My wife has taken treatment at Inamdar Hosptial Pune.
Complain ID : JGJN027966 41 Complaint's Reply
Insurance Complaint
Complaint Date : July 19, 2017
- State : Maharashtra
- City : Pune
- Address: Kalepadal Hadapsar Pune
My wife has taken treatment at Inamdar Hosptial Pune. after taking cashless approval from Emeditek.
After treatment I was in hurry & could not wait for formalities so I paid the bill on my own & decided to submit the claim, since it was pre approved so there were no chances of rejection. Once back to office I submitted documents for claim. After a month I have received a VERY BIG SURPRISE from Emeditek i.e. claim 'Rejected', reason ' The particular treatment is not covered.
If that's the case the why the it was approved for cashless treatment. If this particular disease was not covered then ideally cashless treatment should not have been approved to go ahead.
I took treatment at a hospital which was beyond my budget. If it was not covered then I should have been properly intimated. Same treatment could have been done in 8-10k but since it was approved from Emeditek, I opted for much better Hospital & now big loss for me.
I have been following up with Emeditek Grievance department from 8 month & they have been uttering the same answer, " Claim rejected because this treatment is not covered' they are not responding to my query as to why why this was approved for cashless treatment'. They respond once in two months time & that too just bluff, If its mistake from Emeditek they should accept it & compensate me.
Pls help in getting compensated from Emeditek, either its ignorance or cheating from Emeditek because of which i am suffering.
Please find the claim ID & Policy no.
TPA ID :12305150003368B
CLAIM ID :123061600116
Ins Claim Id :1610002816C052642001
After treatment I was in hurry & could not wait for formalities so I paid the bill on my own & decided to submit the claim, since it was pre approved so there were no chances of rejection. Once back to office I submitted documents for claim. After a month I have received a VERY BIG SURPRISE from Emeditek i.e. claim 'Rejected', reason ' The particular treatment is not covered.
If that's the case the why the it was approved for cashless treatment. If this particular disease was not covered then ideally cashless treatment should not have been approved to go ahead.
I took treatment at a hospital which was beyond my budget. If it was not covered then I should have been properly intimated. Same treatment could have been done in 8-10k but since it was approved from Emeditek, I opted for much better Hospital & now big loss for me.
I have been following up with Emeditek Grievance department from 8 month & they have been uttering the same answer, " Claim rejected because this treatment is not covered' they are not responding to my query as to why why this was approved for cashless treatment'. They respond once in two months time & that too just bluff, If its mistake from Emeditek they should accept it & compensate me.
Pls help in getting compensated from Emeditek, either its ignorance or cheating from Emeditek because of which i am suffering.
Please find the claim ID & Policy no.
TPA ID :12305150003368B
CLAIM ID :123061600116
Ins Claim Id :1610002816C052642001
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Complaint ID : JGJN027966 : 19 jul 2017 by Danish Hasan:
(5 of 5)
Hello,
I have raised the complaint Complaint ID : JGJN027966 on 19 July 17.
So far the company has called only once. Where in they were giving some vague excuses & after that no response, no update till date.
Please help.
Thanks
Danish.
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