TPA MDINDIA - Cashless Authorisation Letter

From: Sita Ram Agarwal <sragarwal1@yahoo.com>
Date: 2 January 2020 at 6:10:18 PM IST
To: MDI - Harpreet Sahota / Customer Care / MDIndia / Head Office - Pune <hsahota@mdindia.com>
Cc: FMRI.OPD@fortishealthcare.com, TPA.FMRI@fortishealthcare.com, NARENDRA.RANA@fortishealthcare.com, AUTOFAX@mdindia.com, DELHI@mdindia.com, IFDDELHI@mdindia.com, DBHARDWAJ@mdindia.com, MUMBAI@mdindia.com, MDINDIA <authorisation@mdindia.com>
Subject: Re: Authorization Letter For CCN : MDI5325131

Mr/Ms Harpreet Sahota,

Manager, Customer Care,

MD India, Pune.

I have recd your msg sent on last Friday, wherein you have given details of deduction of Rs 37,771/- out of final bill dated 21-12-2019 of Fortis Hospital, Gurgaon, as under:-

(1)  A sum of Rs 6,570/- has been deducted towards Alpha Bed Charges. My wife was admitted in the hospital in a very serious condition and to prevent bed soar, hospitals use Alpha Bed for such a patient, who is not able to move. Under the Policy charges of treatment of bed soar, which is quite costly will be payable, whereas charges of preventive measures such as Alpha Bed are not payable. What is the logic in it? Is it in the interest of New India and the patient. I hope this aspect needs reconsideration.

(2) A sum of Rs 29,151/- has been deducted towards consumable items such as camera cover,diaper,urine post, urine bag,urometer, underpaid, wipes, gloves. As my wife is completely bed ridden and can not go to toilet, which will be apparent from discharge summary sent to you by the hospital, how they will handle or manage such a patient. Will Hospital will allow such a patient to pass urine and stool in the clothes and bed sheet and mattress and will the hospital staff will come forward to clean the patient to keep her in good hygiene and free of infection? Please see to the practical side of the these problems. Otherwise what the use of health insurance. Please review this aspect in the light of the condition of the patient. 

(3) A sum of Rs 2,050/- has been deducted towards Document, CD Charges and TPA. I have no control on the documents exchanged between you and the hospital on regular basis. You have mentioned that CD charges can be refunded to me on submission of original paid receipt and Claim Form-A. Firstly when these charges of C D are payable, why these were deducted at the time of approval. I did not ask for a CD. In the usual course, after angiography hospital gave the CD and I have not paid separately and hospital has not issued any receipt to me and when it is a case of cashless, where is the question of submitting any claim form. I even do not know what are charges for CD out of this amount of Rs 2,050/-as they have included all these charges in their bill sent to you directly. Please review this aspect and refund the amount. 

In the end, I would request you to please reconsider all these deductions as the hospital has charged room rental@ Rs 9,000/- per day which is my eligibility in Gurgaon, Haryana. Hence, there is no question of any deduction and the said amount of Rs 37,771/- should be refunded to me at the earliest.

Thanks,

S R Agarwal,

Retd Secy,

LICI, CO.

S R 207257

Mob 8527571711

Sent from my iPad

On 27-Dec-2019, at 5:12 PM, MDI - Harpreet Sahota / Customer Care / MDIndia / Head Office - Pune <hsahota@mdindia.com> wrote:

Respected Sir,

 

Greetings from MDIndia!

 

This is in with regards to below trail e-mail please find claim details are requested :-

 

Deduction details :-

 

Total Deduction  - 37771/-

 

·         Instrument/Monitor/Pulse charges requested amount was 45390/- we gave approval for 38820/- with deduction of amount 6570/-

o    Deduction done towards Alpha Bed charges amounting 6570/-

·         Consumable requested amount was 129689/- we gave approval for 100538/- with deduction of amount 29151/-

o    Deduction done towards are Camera cover, Diaper, Urine Post, Urine bag, Urometer & Underpad

·         Non-payable items requested amount was 2050/- with deduction of amount 2050/-

o    Deduction done towards are Document, CD charges & TPA

 

Hence 37771/- deduction done as per policy terms and condition. However in the above deduction the charges towards CD charges are payable hence request you to kindly submit us with the original paid receipt along with claim form part A which is attached for further processing of amount towards CD charges

 

Attached herewith is the Approval Letter for your ready reference.

  Please feel free to revert in case of any further assistance.

 Thanks & Regards,

Harpreet Sahota,

Manager - Customer Care,

MDIndia Health Insurance TPA Pvt. Ltd.

S. No. 46/1, E-space, A-2 Building, 3rd floor,

Pune Nagar Road, Vadgaonsheri, Pune 411014.

Mobile: +917391042285

Email Address: hsahota@mdindia.com

UAN No: 1860-233-4446, 1860-233-4448

Toll Free: 1800-233-1166, 1800-233-4505