Complaint against MDIndia TPA

 Respected RIEA Members 

Happy Evening & Happy Pongal in advance. 

*Today Myself & Mr.D.Thalakkiah Sir, Met Esteemed Zonal Manager Sir  & Handed Over One More  Memorandum Regarding MD INDIA TPA.

Respected Sir, he has immediately called His Secretary & and asked, "What about Previous Memorandum Submitted By RIEA CHENNAI on 28.10.2024 & 5.12.2024 with Proofs?"

She/He Told That "Already it has been sent to MD & ED  Looking After OS Department at Central Office & Some Cases MD India Has Reconsider it, & Paid 80 % TO 90 %  Amount Which Was First Disallowed.

*This is just a part of our hard work & Today We Asked ZM Sir, *Who is Benefitted By Corporate Discount & Told Him To Recommend This Point To CO* It Should Come To Insured. ( To Us )

He has accepted our views & he has assured Again that he will himself take up the matter with Central Office. 

He has also asked us to send the same to 2 MD & ED.

We will do that immediately. 

Respected Members 

Below is the memorandum we submitted today with drafting by Mr.R.Moorthy Sir.

We thank Shri.R.Moorthy Sir for it.

Yours Truly 

DAVE

RETIRED INSURANCE EMPLOYEES ASSOCIATION

CHENNAI

(Affiliated to All India Retired Insurance Employees Federation)

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  D.Thalakkaiah                                                                                                                Yogesh B.Dave

   President                                                                                                                                           General Secretary

 

To

The Zonal Manager

Life Insurance Corporation of India

Southern Zonal Office

Anna Salai

Chennai – 600001

 

Respected Sir,

               

Sub: Group Medical Insurance Policy No – 12070034240400000008 - with New India Assurance Company Ltd – Unhelpful attitude of MD India Health Care Service TPA Ltd – regarding

 

Ref: our letter dated 25^th November 2024 on the above matter

 

Further to our letter cited in ref above, we hereby submit the details of some more issues being created by the MD India Health Care Services TPA Ltd in our zone.

 

1.       There is very clear mention in the policy document and related annexure about the items which are not allowed by the company; however, even the same items of expenses are allowed if it is absolutely necessitated during the course of operation/treatment as certified by the surgeon/physician. But the TPA totally rejects every such item irrespective of whether the said item is absolutely necessary for the treatment or not.

 

For example, the hand gloves, linen, cotton etc are used during the course of treatment that too only by the hospital in which the patient has no control or say; but the TPA rejects the same in total as non medical items.  

 

2.       The room rent ceiling is already fixed in the policy conditions according to the sum assured and the place of treatment. But it seems that the TPA personnel have entered in to an agreement with the hospitals for a lower amount of rent which is not known to the insured/patient. If the hospital charges more than the agreed rent, instead of taking it with the hospitals the TPA sanctions room rent as per their agreement and the remaining amount is being collected from the Patient.

 

The poor patients already with mental and physical pain pays the same to avoid confrontation and heart burning with the hospitals where they are expected to take further treatment.

 

3.       The TPA specifies a portion of the bill amount as hospital discount and sanctions another portion of the bill; the remaining amount is mentioned as the amount to be paid by the patient. But in many of the cases the hospital collects the entire balance amount, above the sanctioned amount, of the bill. So, factually no discount is available to the patient and the insurer is taking the benefit of discount if any.

 

It is absolutely against all ethics; even if the hospital has agreed to give any benefit of discount the same should be passed on to the patient and not to the insurer.

 

4.       When the Insured/patient is admitted to the Network hospitals, TPA gives Pre authorization; in the said authorization itself the total amount of insurance cover remaining in his account is mentioned and thus made known to the hospitals. This induces the hospitals to charge maximum amount for the treatment; when the claim is processed TPA disallows a portion of the amount as excess claim and ultimately the burden falls on the head of the insured/patient.

 

When we talk to the TPA personnel they say that we should not tell the coverage amount to the hospitals; but they themselves mentions this in their official letter which is contrary to their breaching and practice.

 

5.       The TPA is not transparent in any of their action; after approving a specific Medical procedure/Surgery to be done by the hospital, the amount requested by them is sanctioned partially in the pre - authorization letter. This reduction confuses the patients and leaves them in uncertainty about the amount to be paid by them. On what basis this requested amount is reduced and what is the guarantee for the remaining amount to be paid is unknown.

 

For specific procedures like cataract surgery etc where the maximum expense amount is fixed, the TPA sanctions a reduced amount initially.

 

6.       In many cases the Pre authorization is either not given or given but canceled subsequently putting the patient in to an embarrassing position. In all such cases no reason is attributed for the action of the TPA.

 

7.       In a few other cases full amount of claim is not sanctioned for Cashless facility; those who raises objection are advised to make a further claim under reimbursement procedure which nullifies the purpose of cashless facility.     

 

Sir,

 

Life Insurance Corporation of India has devised Mediclaim scheme by spending huge amount, on the 75% subsidized premium, in order to protect the welfare of their employees at their old age. But the goodwill and magnanimity of the Corporation is unable to be understood because of the bad treatment met out by the pensioners and family pensioners at the hands of TPA personnel.

 

Sir,

We on behalf of the retired employees request your good selves to intervene and take up the matter to the appropriate forum to redress our genuine grievances against the TPA and keep us safe, peaceful and pain free.

Thanking you sir

Yours faithfully

 

 

 

D.Thalakkaiah Yogesh B Dave   

Chennai

06/01/2025