Apr 26, 2016 07:46 PM
72529 Views
Cashless approval within 4 hours have been recived from Maxbupa, but services of M/S Nandana Health care services(KADE HOSPITAL), Rajaijinagar, Bangalore-10 is very bad, far from satisfactory, undue delay & little bit harassment to patients.
My daughter has a policy to her mother in law for 2laks, when her mother in law feels abdomen pain, she consulted regular doctor & found that she has hernia problem & the doctor has suggested surgery with an advice to go treatment in kade hospital since the hospital has cashless facility with M/S Maxbupa.
As per advice of our doctor my daughter has taken her mother in law for admission to the hospital at 10 P.M trouble starts from the on-wards as detailed below.
Even after furnishing insurance details the hospital people has asked to deposit Rs 40, 000 as an advance instead of 5to10% of cost of surgery. The hospital has taken their own time to submit cash less approval request though all the papers have been furnished.
The Insurer has given approval for cash less within 4 hours. The hospital people has prepared different bills at different times with one bill having double the cost of surgery.
After surgery they have advised the patient to go home the very next day. Next day they have taken their own time o submit final bills to the insurer with missing of one item & missing of one document from the hospital. Due to all this approval from the insurer has been received only next day. The patient has not been discharged for want of approval from the insurer. Bills are not prepared properly, which leads to disallow some amount.
Again for refund of advance they taken their own time made my daughters in law to wait up to 9P.M. While appreciating & thanking the insurer for taking quick decision for approval of cashless treatment, I want to know from the insurer why such hospitals are being listed for cashless treatment, when they are not able to provide health services to the patients like above. Therefore I request the insurer to see that net worked hospitals should not harras un necessarly to the patients as stated above in critical times. Further it was requested the insurer to look in to cash less approval which was fully approved due to non furnishing of proper information by the hospital.When questioned about this to hospital people they are not able to explain why such things happens as stated above.
UPDATED ON Jul 19, 2016:
I have gone through all the comments for & against this insurer by no of policy holders & since I am also one of policy holder of this company, I wish to share some infmn of my experience with the insurer. Once my spouse attacked with serious ailment, all reimbursement claims have been honoured by this insurer in time as promised by them.
Further I have undergone some surgery some time ago, this was also reimbursed fully as per terms & conditions of policy by the insurer. When claims are genuine with all required documents, there is no way to the insurer to reject/deny the claims. Now a days everybody is thinking about their health very seriously seeking health insurance which is become essential & needed very much to met heavy hospitalization cost. It is very necessary to know terms & conditions before buying a health policy of any insurer by calling insurers advisor/official to explain all the terms, conditions, benifits, premium rate etc in person & then buy only if you are satisfied. Now in one of serious comment it has been stated that policy document is having 100 pages with small printed words, no body can able to read the same.
In this regard I wish to clarify that in fact policy contains only 35 pages which includes policy certificate, premium receipt, other pages are containing terms & conditions, benefits, exclusions etc as the same is mandatory on part of insurer for the information of policy holder as per IRDA regulations. When we opted to buy a policy proposer has to fill the form which contains age, add, occupation, & health details such as past history of health of person/persons to be insured since this form is very important document for all the claims.
Non disclosure of past health history, pre existing diseases leads to denial of claims that is up to past 7years & conditoin of the same at the time of proposal. Even if proposal form was not written by proposer there is no need to worry as there is a free look period of 15 days from the dt of receipt of policy document along with copy of proposal form, so that proposer can go through all the details in the form & intimate the insurer to correct any errors if found & can be cancelled the policy if no correction made by the insurer within freelook period so that insurer will refund the premium amount. As far as medical check up is concerned, the same may or may not be done on basis of infmn provided in the form up to age of 45 to 49 years. In other cases i.e above 50 years medical check up will be done by the insurer free of cost. These procedures are followed by all the insurers. Always do not buy on line just for want of time & also not from any insurer having TPA arrangement.
Do not buy any health policy on instalment basis, since coverage may not be available until full amount is received. Therefore it is always better to go through all terms & conditions carefully even sparing free time for this & buy the policy otherwise no purpose will be served after buying thesame.
