CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE S R 207257

From: Sita Ram Agarwal <sragarwal1@yahoo.com>
Date: 4 May 2019 at 6:38:08 PM IST
To: co_eos <co_eos@licindia.com>
Cc: "rsrinivasan@mdindia.com" <rsrinivasan@mdindia.com>
Subject: Re: CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE S R 207257

LIC OF INDIA

OS DEPTT.                                 

MEDI-CLAIM SECTION.                                                  Dt 4th May,2019.

CO, MUMBAI

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                                          PERSONAL ATTENTION ASSTT. SECY( OS)

                                          ===============================

I submitted a claim for Rs 10,059/- sent to you by registered post on 18-03-2019 as under:- 

Bill dated 01-3-2019.          ARTEMIS Hospital.          Rs 2,289/-       Emergency charges

Bill dated 02-03-2019.        Fortis Hospital.                Rs 2,856/-       Head C T scan

Bill dated 15-03-2019.         ARTEMIS Hospital.          Rs 4,914/-       Stress Echo

I sent to you original bills, reports and prescriptions and all these documents were sent by you to MD India, Pune.

MDIndia paid to me total Rs Rs 4,356/- as under:-

Rs 2,856/- as Head C T

Rs 1,500/- as Stress Echo

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Rs 4,356/-

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They paid Rs 1,500/- towards Stress Echo against Bill of Rs 5,460/-.Whereas our Medi-Claim Policy provides in Clause C on Page 10 as TMT Rs 1,200/- and Rs 1,500/- Echo Test. In the prescription dated 05-03-2019, the Cardiologist prescribed as STRESS ECHO ONLY IF RESTING ECHO IS NORMAL. The Report of Artemis Hospital is in two parts as BASELINE ECHO AND EXERCISE STRESS ECHO.

I underwent two tests in Artemis Hospital, firstly normal Echo and since it was normal, I underwent Stress or Exercise Echo on TMT. Thus I am entitled for a sum of Rs 2,700/-for both echo ie normal echo and stress echo, whereas MDIndia has allowed only Rs1,500/- as TMT, which is wrong.

On 10-04-2019 on receipt of their approval for only Rs 4,356/-, I represented to them to pay 1,200/- also towards normal echo. They did not reply and I  sent them a Reminder on 17-04-2019 and when no response was recd even after this reminder, I telephoned Sri RAJESH SRINIVASAN, AGM Operations, when he told me that he is not a medical man and  matter has been referred to New India Assurance and I should wait upto 2nd May. When I did not receive any reply till 3rd May, I sent a reminder today morning to Sri RAJESH and he immediately sent his reply that he is still awaiting response from New India Assurance, but in the evening he has sent a message to you today that he has correctly settled the bill and I am not satisfied. IN THIS REPLY HE HAS NOT CLARIFIED THAT THE REPLY HAS  RECEIVED FROM NEW INDIA AND THEY HAVE ALSO AGREED TO HIS DECISION.

 I would request you to please take up the matter with New India Assurance as well as M D India to allow Rs 1,200/- also. You may please also take up the issue that MDINDIA is not sensitive and do not respond to the messages of the beneficiaries even at the level of AGM Operations of MD India.

I would await your reply at the earliest.

Thanking you,

S R Agarwal

Retd Secy(HPF)

LIC, CO, MUMBAI

Mob 08527571711

On 04-May-2019, at 4:30 PM, co_eos <co_eos@licindia.com> wrote:

 

 

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From: MDI - Rajesh Srinivasan / Operations / MDIndia / Mumbai branch [rsrinivasan@mdindia.com]
Sent: Saturday, May 04, 2019 14:32
To: co_eos
Subject: RE: CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE S R 207257

Dear sir,

We have reverted to the Employee on the same however he is still not convinced on the same.

Deduction is in order PFB details

Echo charges as per bill Amt – 4914/- & only payable in LIC Rs. 1500/-  & deduction Amt – 3414/-

Head CT charges fully paid Amt – 2856/-

Total Paid Amt – 4356/-

Amt 2289/- charges deduction as per policy terms & condition  (clause No – C1 )

Regards,

Rajesh Srinivasan

AGM - Operations

MDIndia Health Insurance TPA Pvt. Ltd.

Mezzanine floor, Ballard House

Adi Marzban path, Ballard Estate

Bearing CTS number 1185

Mumbai – 400 001

Mobile: 91-09321301023

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

Visit us @ www.mdindiaonline.com

From: co_eos [mailto:co_eos@licindia.com] 
Sent: 04/May/2019 11:14 AM
To: rsrinivasan@mdindia.com
Subject: FW: CLAIM PATIENT S R AGARWAL MDI 4825775 LIC RETIREE S R 207257

Dear Sir,

Trailing mail from Shri S R  Agarwal, Secretary(Retired) is forwarded for necessary action

OS Dept

CO

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