Dear Sri Sahni,
Your mail inviting problems and suggestions for the above noted policy is most welcome and timely. I have no words to express my sincere thanks for your this initiative. I have to state as under:-
PROBLEM WITH TPA M D INDIA
========================
When they make deductions from the claim, they do not simultaneously inform the details of the items disallowed, and when msg is sent to know the details, they usually do not respond. It is a great deficiency of service on their part. In fact, a lot of follow up falls on deaf years. Secondly, their Reply, even if recd by chance, it is very short and does not satisfy the query.
MISINTERPRETATION OF POLICY CONDITIONS BY THE TPA
===========================================
(1) Policy Clause under Heading A-COVERAGE on S N 2 on page 3 read with Annexure-I provides room rent payable in hospitals in various cities and this clause does not say anywhere that these rates are inclusive of NURSING CHARGES. But the TPA always calculate and process the claim on the basis of room rent charged by the hospital after adding their in nursing charges also and other expenses are reduced in proportion thereof, which is detrimental to the interest of the beneficiaries.
SUGGESTIONS FOR THE POLICY FOR THE YEAR 2018-19
==========================================
(1)(b) Clause-C on page 10 provides for payment of various diagnostic tests If these are prescribed by a doctor having minimum qualification MD or equivalent, but it is ironical that the consultation charges payable to the doctor, who prescribes such test, are not payable, and this anomaly should be removed. No doctor of this level will be available to anyone free of cost.
(c) Further, the limits of the amounts for various tests needs upward revision.
(2) That SN 8 of Clause-D on page 12 provides for a payment of Rs 25,000/- per eye per year for the eye ailment of AGE RELATED MOCULAR DISORDER, which is grossly inadequate inasmuch as such treatment needs minimum 3 injections per eye, in some cases may be more, and each injection costs about Rs 20,000/-.Thus, this limit needs to be increased to minimum Rs one lac per eye per year or, in the alternative, this item should be included in the category of LESS THAN 24 HRS HOSPITALIZATION, because these injections are given in a hospital or a well established eye clinic by a retina expert in the operation theatre and a patient requires minimum 3-4 hours stay in the hospital or the clinic.
Pl include all these items in the representation to LIC for negotiating the terms and conditions of the policy for the year 2018-19 with New India Insurance Co.
PLEASE ALSO CIRCULATE MY THIS MAIL ON YOUR BLOG FOR INFORMATION OF ALL.
Thanks,
S R Agarwal
Retd Secy,CO,
Now at Gurgaon
Mob 08527571711
Email: sragarwal1@yahoo.com
Your mail inviting problems and suggestions for the above noted policy is most welcome and timely. I have no words to express my sincere thanks for your this initiative. I have to state as under:-
PROBLEM WITH TPA M D INDIA
========================
When they make deductions from the claim, they do not simultaneously inform the details of the items disallowed, and when msg is sent to know the details, they usually do not respond. It is a great deficiency of service on their part. In fact, a lot of follow up falls on deaf years. Secondly, their Reply, even if recd by chance, it is very short and does not satisfy the query.
MISINTERPRETATION OF POLICY CONDITIONS BY THE TPA
===========================================
(1) Policy Clause under Heading A-COVERAGE on S N 2 on page 3 read with Annexure-I provides room rent payable in hospitals in various cities and this clause does not say anywhere that these rates are inclusive of NURSING CHARGES. But the TPA always calculate and process the claim on the basis of room rent charged by the hospital after adding their in nursing charges also and other expenses are reduced in proportion thereof, which is detrimental to the interest of the beneficiaries.
SUGGESTIONS FOR THE POLICY FOR THE YEAR 2018-19
==========================================
(1)(b) Clause-C on page 10 provides for payment of various diagnostic tests If these are prescribed by a doctor having minimum qualification MD or equivalent, but it is ironical that the consultation charges payable to the doctor, who prescribes such test, are not payable, and this anomaly should be removed. No doctor of this level will be available to anyone free of cost.
(c) Further, the limits of the amounts for various tests needs upward revision.
(2) That SN 8 of Clause-D on page 12 provides for a payment of Rs 25,000/- per eye per year for the eye ailment of AGE RELATED MOCULAR DISORDER, which is grossly inadequate inasmuch as such treatment needs minimum 3 injections per eye, in some cases may be more, and each injection costs about Rs 20,000/-.Thus, this limit needs to be increased to minimum Rs one lac per eye per year or, in the alternative, this item should be included in the category of LESS THAN 24 HRS HOSPITALIZATION, because these injections are given in a hospital or a well established eye clinic by a retina expert in the operation theatre and a patient requires minimum 3-4 hours stay in the hospital or the clinic.
Pl include all these items in the representation to LIC for negotiating the terms and conditions of the policy for the year 2018-19 with New India Insurance Co.
PLEASE ALSO CIRCULATE MY THIS MAIL ON YOUR BLOG FOR INFORMATION OF ALL.
Thanks,
S R Agarwal
Retd Secy,CO,
Now at Gurgaon
Mob 08527571711
Email: sragarwal1@yahoo.com
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