CCN : MDI5325131 ECS PAYMENT DONE FOR PUSHPA, IC CLAIM NUMBE

Mr/Ms Harpreet Sahota,

MDIndia, Pune

I have recd your msg that you have deducted a sum of about Rs 70,826/- out of the claim of Rs 1,59,873/-. Before I give my comments on this deduction, I have to bring to your notice the following facts:-

Firstly, my wife is totally bed-ridden for quite a long time unable to sit or even stand with walker. Secondly, whatever medicines or items have been given to her are as per the advice of Dr Praveen Gupta, Neurologist of Fortis Hospital, who has been treating her since the year 2015. Thirdly, her last hospital bill for one month is over Rs 10.5 lacs, whereas the bill for two months post hospitalisation is only around is Rs 1.5 lacs and she would have continued in the hospital but on my insistence she was discharged on 21-12-2019. Fourthly, I have tried to purchase medicines etc at the maximum discount from various sources to reduce expenses, which is in the interest of New India and some on line bills may have a few discrepancies, which are difficult to have them corrected as  per your objections at this stage. 

MY COMMENTS ON EACH ITEM ARE AS UNDER:-

BILL NUMBER	DATE	AMOUNT	COMMENTS
010.	05-02-2020	1700/-	This bill is for 10 GLUTOPRO SATCHET. It Is to regulate stomach disorder. These are prescribed in the prescription dated 04/01/20 sent to you.
011	16-02-2020	1700/-
104012.	19-02-2020	506/-	Pl see Prescription dated 06-01-2020 of  Dr Praveen Gupta for Soframicin for bed soar( left hand lower side). See prescription dated 31-01-2020 item 3.
1180.	19-02-2020	10000/-	As per Scheme, physiotherapy charges are payable unto Rs 40,000/- as per Page 22 and Clause xxv.
——	21-11-2019	2,737/-	I have not sent any such bill in my Claim Forms sent to you. Pl send email of this bill.
21415.	28-12-2019	349/-	You have disallowed all these items on the ground of non-medical items and the Farmacy receipt not submitted. I have mentioned that she is aged 84 yrs and bed ridden for a long time and for such a patient for  motion on bed how such cleaning items as diapers, underpads, wipes, mask, gloves can be non-medical items.  All these items were disallowed by you  in the Hospital bill on 21-12-2019, but on my representation, you, in view of age and condition of patient, you later on allowed and refunded the amount. You may also be knowing that when items are obtained on line, payment is either made through credit or debit card or given to the delivery boy and there is no other separate receipt. The bill is enough and you had allowed the payment in case of earlier claims.
21753.	02-01-2020	998/-
27885.	08-02-2020	717/-
26144.	16-02-2020	499/-
4572.	23-11-2020	1,100/-
4480.	17-01-2020	1,059/-
147448.	25-01-2020.	1,386/-
4755.	02-02-2020	5,483/-
5093.	18-02-2020	3304/-
95162.	27-01-2020	146/-
10230.	15-02-2020	378/-
4326	05-01-2020	2,998/-
4248	29-12-2019	2,896/-	These items have been disallowed due to non submission of cash receipts of pharmacy bills and prescription for certain medicines. All these items have been purchased from the pharmacy bearing GST AND LICENCE NUMBER. These pharmacies are delivering the medicines with these bills and the payment is made to the delivery boy. Therefore there is no question of another receipt. You have raised this objection for the first time after so many claims. Medicine lexopeg is already prescribed on page 7 of the hospital discharge summary, which has been continued in the subsequent prescription of the doctor. Injection wepox is prescribed in various prescriptions dated @ weekly/10 days of Dr. Praveen Gupta. Axelon-5 patch has been prescribed by the doctor in the prescription dated 06/01/2020 sent to you.
4404	12-01-2020	1,850/-
4682	30-01-2020	1,898/-
4563	21-01-2020	1,898/-
4841	06-02-2020	1,898/-
4781	04-02-2020	5,037/-
5011	13-02-2020	1,898/-
5094	18-02-2020	5,037/-
4349	07-01-2020	5,415/-
86645	31-12-2019	590/-	Rogan badam (almond oil) has been prescribed by the doctor for  massage on legs in the last but one page of the discharge summary and prescription dated 06/01/20 sent to you, to bring strength in the legs to make her to stand. Syrup bro-zedex has been prescribed on Og 6 of discharge summary. For lexopeg please refer to above column. Osteophagus-35 and bonshine-60k have been prescribed by the doctor dated 24/12/19 sent to you. As regards tablet rifagut and creamalax were advised by the doctor on the telephone because of constipation and diarrhoea. Doctor in the hospital is 10km away from my residence it is not possible to get the prescription from him and in case of emergency he consults on phone
89787	09-01-2020	447/-
102449	15-02-2020	113/-
101695	13-02-2020	231/-
1160	19-01-2020	800/-	The correct date of this bill is 19/01 and not 09/01. No nurse is available for rs 800. The patient is already on the bed having catheter for passing urine for more than 6 months and you must be aware that the catheter has to be changed after every 3-4 weeks to avoid infection. In addition the doctor has prescribed to change the catheter in his prescription dated 14/01/20 sent to you. I can't change the catheter. It can be done only by a qualified nurse and these charges are for the change in Catheter and in earlier bills also you have allowed these expenses
184803	07-12-2019	410/-	This the computer generated bill from the Fortis hospital wherein date and time are mentioned. It is not understandable how a computer generated bill of the hospital is not acceptable. You may be aware that in so many computer generated msgs signatures and stamps are never available. No other bill for this amount has been submitted by me.
89630	17-01-2020	639/-	My efforts have been to obtain the maximum discount, which are available through online, which is a known fact. My late daughter-in-law, Nalini AGARWAL and son Sandeep AGARWAL are registered for online purchases and they help me to purchase the medicines online. At my age of 84, I am unaware of online process and that is why these bills are in their names but all the items have been used for my wife.
130508	27-01-2020	866/-
1340	23-12-2019	280/-
1929	02-01-2020	2100/-
16417829	24-01-2020	229/-
115	24-01-2020	398/-
4624151	08-02-2020	600/-
12082676	08-02-2020	236/-

         TOTAL                                           70,826/-        

It seems that all these items have been disallowed at a hurriedly glance without thoroughly going through the discharge summary of the hospital and the prescriptions of the doctor already sent to you and moreso, some of these items have already been allowed by you in earlier claims, if one or two item is not prescribed, these were advised by the doctor on the phone. I am not a medical man who would give such medicines myself without consulting the doctor. Our mediclaim Scheme is a welfare Scheme and it should be construed in a constructive and positive manner and not on technical grounds. You can see the history in the discharge summary of my wife suffering from various ailments and the case should have been examined keeping in view the total background.

 

Please allow all these items and remit the amount at the earliest.

Thanking you,

S.R AGARWAL

Retd. Secretary

L.I.C, C.O

Mumbai

S.R no. 207257

Mob. 8527571711