APPANABHTOLA NARASIMHA RA
New member
- Policy Name
- health insurance policy
- Company Name
- ADITYA BIRLA HEALTH INSURANCE COMPANY LIMITED
- Customer Care Number
- 18002707000
- Loss Amount
- 1000000
- Ratings
- Opposite Party Address
- ADITYA BIRLA HEALTH INSURANCE COMPANY LIMITED, First Floor, 19/4, Sair Bagh, Bengaluru (Bangalore) Urban, Cunningham Road, Bengaluru, Karnataka 560052
My policy Number: GHI-HB-22-2090538-V2 & GHI-71-24-4720936-000 and registered phone number: 9642534000
A.NARASIMHA RAO-KNEE SURGERY CLAIM ID:1222385093540
A. PRAVEENA – UTI FEBRILLE ILLNESS- CLAIM ID:1212585037771
I am writing to formally appeal the rejection of my claims under policy number referred above , which were related to my treatment for a knee injury and my wife's medical treatment. Both claims were initially pre-authorized for cash less treatment, but I was later informed that my claim have been repudiated and my wife claim rejected for cashless and to go for reimbursement. As I have failed once in claiming procedure of my knee injury instance, now I have opted to approach through you of my wife Smt. A. Praveena insurance claim also. I remind you that I have sent legal notice also through a paid lawyer for claiming my amount but there is no response from ABHIL which copy also enclosed herewith.
Specifically, I would like to address the following issues:
Hypertension Allegation for me A.NARASIMHA RAO: The rejection letter cites hypertension as a reason for repudiation of my claim, however, my treating doctor has certified that I do not have hypertension and that it was related to the accident. I am attaching the relevant medical certification for your review. And also i am attaching the total expenses statement for your immediate reference. The rejection letter also cites that due to multiple discrepancies, the claim was rejected. I am unable to understand, what is multiple discrepancy what I shall clarify and hence, I had approached ABHIL team by toll free number numerous times (150 call nearly) to find out the multiple discrepancy rejection reasons, to my surprise all the times ABHIL team insisted that they cannot reveal. Kindly imagine my situation after having an injury and keeping two health insurance policies of Rs 10 lakhs and 50 lakhs.
Obesity Allegation for My Wife: The rejection of my wife’s claim states that she is obese, which was never disclosed by us at the time of taking the policy and or before starting the treatment or at least at the time of pre authorization under cash less treatment. Additionally, there is no mention of her weight in the policy documents provided to us and it is definitely the work of sale representative or any internal team of Aditya Birla Health Insurance Company Limited without our knowledge. Regular renewal of my policy is done online as per the mobile call representatives(telecallers). The expenses statement is attached herewith for your reference.
Considering these points, I kindly request a thorough review of the claims and supporting documents in the best interest to do justice to a common man. I would appreciate it, if you could make the health insurance provider to reconsider their wrong decision based on the updated information I have provided. Further I would like to get to your notice that I am continuing my 6th year in Aditya Birla Health Insurance and I am never a defaulter in payment of Premium amount though I am a small employee in a flour mill accounts section. By hook or crook I am honoring the payment of my Health insurance premium timely, all the time since started in 2019 with a strong belief and hope that at bad times of me and my family health issues, Aditya Birla Health Insurance Company Limited will save and rescue us. I trusted blindly the team of Aditya Birla Health Insurance Company Limited and continued my policy and renewing same online every year by taking finance from Bajaj Finance and paying EMI regularly. Here I mention to you that Basically I have health insurance policy of 10 lakhs as Base Policy. But one fine day, I have got calls from Tele caller Sale Rep of ABHIL mentioning to me that I have an exclusive offer for a Top up of Rs.50 lakhs Insurance at low premium which covers Me and My family and I have taken the same with blind trust in ABHIL and even that is also online process only vide Policy No.71-21-00107-00-01.
I am facing significant financial hardship in payment of my current insurance premium EMI and I am continuing even after these 2 claims rejection, the financial problem got doubled in my life. As the medical bills for both Myself and My Wife remain unpaid by ABHIL, literally I am unable to repay borrowed amounts without the reimbursement by any means. I am getting warnings, demand and torture from the people I have borrowed from, for me and my wife health issues. Even now it is brain hammering for me that why the ABHIL team (Insurance provider) is not considering my legitimate / genuine claims.
I would be grateful for a prompt resolution and am hopeful for your understanding and support in this matter in convincing the insurance provider to release my genuine claims on war foot basis. As the policies I have taken are online, I am in complete gloom to whom to contact about the procedure of emergency admissions, in claim procedure and submission of papers. Therefore, I am at complete helplessness. Please let me know if further documentation or clarification is required. This is how I am expressing my eye tearful grievance.
Thank you for your attention to this urgent matter.
Kind Regards,
A.NARASIMHA RAO
A.NARASIMHA RAO-KNEE SURGERY CLAIM ID:1222385093540
A. PRAVEENA – UTI FEBRILLE ILLNESS- CLAIM ID:1212585037771
I am writing to formally appeal the rejection of my claims under policy number referred above , which were related to my treatment for a knee injury and my wife's medical treatment. Both claims were initially pre-authorized for cash less treatment, but I was later informed that my claim have been repudiated and my wife claim rejected for cashless and to go for reimbursement. As I have failed once in claiming procedure of my knee injury instance, now I have opted to approach through you of my wife Smt. A. Praveena insurance claim also. I remind you that I have sent legal notice also through a paid lawyer for claiming my amount but there is no response from ABHIL which copy also enclosed herewith.
Specifically, I would like to address the following issues:
Hypertension Allegation for me A.NARASIMHA RAO: The rejection letter cites hypertension as a reason for repudiation of my claim, however, my treating doctor has certified that I do not have hypertension and that it was related to the accident. I am attaching the relevant medical certification for your review. And also i am attaching the total expenses statement for your immediate reference. The rejection letter also cites that due to multiple discrepancies, the claim was rejected. I am unable to understand, what is multiple discrepancy what I shall clarify and hence, I had approached ABHIL team by toll free number numerous times (150 call nearly) to find out the multiple discrepancy rejection reasons, to my surprise all the times ABHIL team insisted that they cannot reveal. Kindly imagine my situation after having an injury and keeping two health insurance policies of Rs 10 lakhs and 50 lakhs.
Obesity Allegation for My Wife: The rejection of my wife’s claim states that she is obese, which was never disclosed by us at the time of taking the policy and or before starting the treatment or at least at the time of pre authorization under cash less treatment. Additionally, there is no mention of her weight in the policy documents provided to us and it is definitely the work of sale representative or any internal team of Aditya Birla Health Insurance Company Limited without our knowledge. Regular renewal of my policy is done online as per the mobile call representatives(telecallers). The expenses statement is attached herewith for your reference.
Considering these points, I kindly request a thorough review of the claims and supporting documents in the best interest to do justice to a common man. I would appreciate it, if you could make the health insurance provider to reconsider their wrong decision based on the updated information I have provided. Further I would like to get to your notice that I am continuing my 6th year in Aditya Birla Health Insurance and I am never a defaulter in payment of Premium amount though I am a small employee in a flour mill accounts section. By hook or crook I am honoring the payment of my Health insurance premium timely, all the time since started in 2019 with a strong belief and hope that at bad times of me and my family health issues, Aditya Birla Health Insurance Company Limited will save and rescue us. I trusted blindly the team of Aditya Birla Health Insurance Company Limited and continued my policy and renewing same online every year by taking finance from Bajaj Finance and paying EMI regularly. Here I mention to you that Basically I have health insurance policy of 10 lakhs as Base Policy. But one fine day, I have got calls from Tele caller Sale Rep of ABHIL mentioning to me that I have an exclusive offer for a Top up of Rs.50 lakhs Insurance at low premium which covers Me and My family and I have taken the same with blind trust in ABHIL and even that is also online process only vide Policy No.71-21-00107-00-01.
I am facing significant financial hardship in payment of my current insurance premium EMI and I am continuing even after these 2 claims rejection, the financial problem got doubled in my life. As the medical bills for both Myself and My Wife remain unpaid by ABHIL, literally I am unable to repay borrowed amounts without the reimbursement by any means. I am getting warnings, demand and torture from the people I have borrowed from, for me and my wife health issues. Even now it is brain hammering for me that why the ABHIL team (Insurance provider) is not considering my legitimate / genuine claims.
I would be grateful for a prompt resolution and am hopeful for your understanding and support in this matter in convincing the insurance provider to release my genuine claims on war foot basis. As the policies I have taken are online, I am in complete gloom to whom to contact about the procedure of emergency admissions, in claim procedure and submission of papers. Therefore, I am at complete helplessness. Please let me know if further documentation or clarification is required. This is how I am expressing my eye tearful grievance.
Thank you for your attention to this urgent matter.
Kind Regards,
A.NARASIMHA RAO
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