We have a hospital at Rajahmundry, EG Dist, Andhra Pradesh, and have empanelled some insurance TPAs. At the time of admission of patient for cashless treatment, we submit the estimate and obtain pre-authorisation.

We submit the bill at the time of discharge and get the payment reimbursed.

In a similar manner, we obtained pre-authorisation for ₹80,000 in June, 2018. After regular follow-up, the bill was settled for ₹30,000 in February 2019, after a delay of eight months. No reason has been given for short payment and there has been no response from them. They are not divulging the details of their grievance redressal authority. So, can you tell us the way out?

P Venkateswara Rao, Rajahmundry

 

Questioninsurance
 

 

For any issue, the first step is to approach the grievance redressal cell of the insurance company. But in this case, as you are not getting a proper response, it is suggested that you approach the Ombudsman. The Insurance Ombudsman is appointed by the Government of India for settling complaints of individuals and others against insurance companies, out of the courts, in a fair manner.

It is not necessary that you have to engage a lawyer to make a complaint to the Ombudsman. Offices of Ombudsman are distributed across 17 cities in the country, the details of which are in the website http://ecoi.co.in/ombudsman.html .

You can approach the Office of the Ombudsman in Hyderabad. The email id is bimalokpal.hyderabad@ecoi.co.in . It is suggested that you first mail the ombudsman with facts of the case and mention details of the TPA and the insurance company. Then, if need be, meet the Ombudsman in person. If there is difficulty in reaching the Ombudsman, you can complain to IRDAI online through the regulator’s Integrated Grievance Management System at https://igms.irda.gov.in/ .

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