CARE HEALTH INSURANCE Request for Assistance with Insurance Claim Issue

R

RAJEEV KUMAR

New member
Policy Name
HEALTH INSURANCE
Company Name
CARE HEALTH INSURANCE LIMITED
Customer Care Number
18001026655
Loss Amount
115921
Ratings
5.00 star(s)
Opposite Party Address
Vipul Square, 3rd floor, Golf Course Road, Sector 43 near rapid metro station Gurgaoj
Dear Sir,


I am writing to inform you about a medical treatment and insurance clime amount - related issue concerning our child, Master Abhiraj Kumar Yadav November 2024.


He had been suffering from a fever for the past six months, occurring continuously every three weeks in a month. We initially consulted a doctor at Park Hospital, who reviewed his reports and prescribed medication. However, his condition did not improve.


We then sought treatment at Motherhood Hospital, located in Sector 57, Gurgaon. Unfortunately, the hospital did not offer a cashless facility. A GMONEY agent assured us that the full amount would be paid from their side and later claimed from our insurance provider.


The total bill issued by Motherhood Hospital was ₹115,921. However, the illness could not be properly diagnosed there, and the case was referred to Fortis Hospital. The GMONEY agent collected all the invoices and facilitated the discharge from Motherhood Hospital.


Our child was admitted to Fortis Hospital for 15 days, where cashless treatment was available, and all invoices amount ₹218,000. were settled directly.


Now, the insurance company is claiming that the illness was treated on an OPD (Outpatient Department) basis, which we believe is incorrect. We have already submitted all required documents, including:


  • Prescriptions and reports from Park Hospital
  • Prescriptions, reports, and discharge summary from Motherhood Hospital
  • Fortis Hospital records

I am a simple person and not a medical professional. We trusted the process and followed all instructions, yet the matter remains unresolved and the amount is still not reimbursed.


I kindly request you to look into this issue and help us resolve it at the earliest.


Thank you for your support.


Sincerely,
[Rajeev kumar]
[Contact nob 9717366750]
 
Dear Sir,

Please find the attachment OPD Perception and report of Park Hospital, Motherwood Hospital all document which through we have climed with Care Health Insurance,
And also find the attachment care health insurance reply.
 

Attachments

Hello @RAJEEV KUMAR

I'm sorry to hear about the challenges you're facing with your Care Health Insurance claim. Under the Consumer Protection Act, 2019, particularly Section 2(11), "deficiency" is defined as any fault, imperfection, shortcoming, or inadequacy in the quality, nature, or manner of performance required to be maintained by or under any law or contract. Delays or denials in settling insurance claims can constitute such a deficiency. Here's a structured approach to help you address this issue:


📝 Step-by-Step Grievance Redressal Process​

1. Contact Care Health Insurance Customer Support​

Initiate your complaint by reaching out to Care Health Insurance through the following channels:
Ensure you provide all relevant details, including your policy number, claim reference number, and any supporting documents.

2. Escalate Within Care Health Insurance​

If your issue remains unresolved:
  • Step 2: Email the Manager – Customer Service.
  • Step 3: If still unresolved, escalate to the Head – Customer Service.
Contact details for these officials can be found in the Grievance Redressal section of Care Health Insurance's website.

⚖️ Legal Notice​


If you have not received any response from the care insurance, we suggest you to send a Legal Notice to the CMD of the Care Health Insurance. If you require assistance in drafting a legal notice or navigating the complaint process, consider consulting our legal professional specializing in consumer protection law. They can provide guidance tailored to your specific situation.

4. File a Complaint with the Consumer Forum​

If the issue persists, you can file a complaint with the appropriate Consumer Disputes Redressal Commission:
This platform allows you to file complaints electronically with the relevant consumer forum.


📄 Documentation Checklist​

When pursuing your complaint, gather the following documents:
  • Policy Documents: Your health insurance policy and any endorsements.
  • Claim Submission Proof: Acknowledgment receipts, claim forms, and correspondence.
  • Medical Records: Bills, prescriptions, discharge summaries, and other relevant medical documents.
  • Communication Records: Emails, letters, and call logs with Care Health Insurance.
  • Documents Required: INDXE, MEMO, EVENTS and AFFIDAVIT.

If you need further assistance or have additional questions, feel free to ask.

Thanks
 
Back
Top