- Apollo Munich excruciating experience during claims ^Open

Deepak Varde filed this complaint against Apollo Munich Health Insurance on Aug 12, 2019

It is with utmost displeasure that I am writing to you on my experience with Apollo Munich towards my son’s hospitalization. Below is the sequence of events that leads to my ordeal.

My son was hospitalized on the night of **th May on the instructions of his pediatrician as the reason for his depleting hemoglobin count was not being identified.

All reports submitted to Apollo Munich lead to establishing that they had to conduct various tests to ascertain the cause of depleting hemoglobin
count. This included a blood transfusion as well.

Looking beyond the experience I had at the hospital despite having a cashless policy where I was made to coordinate with their helpless TPA, I settled the hospital bills in cash.

Later when I submitted my claims, Apollo Munich's claims team wrongly interpreted the doctor’s statement and rejected the claim as they believed it is a pre-existing disease despite him stating that it was not identified during birth. (This is the basis of rejection that has been maintained with me on all communications – in all mails as attached).

Basis this wrong interpretation, I was accused of having withheld facts while taking the policy and thereby my policy was terminated.

When I requested the grievance cell to reconsider the matter, they asked me to get them an undertaking from the treating doctor for his clarification on the same note that is being referred as the basis of rejection of claims. (which Apollo's team wrongly interpreted as pre-existing disease)

The doctor gave a statement that it should be read as “Normal” and “Not Deficient” and that Apollo Munich's team had misread and misunderstood that it was diagnosed during birth on cord blood.

On **th July **** I receive a call from the grievance team stating that they have decided to continue my policy however we will not admit
the claim as it is a genetic disorder which is not admissible as per the policy.

Apollo Munich's team realizes that they’ve made a mistake, so they bring in a new aspects to convince me that it is mentioned in the policy that
genetic disorder is not covered. If that was the case, why was I made to go through all the episode of getting the doctor’s statement on a stamp paper and then requesting him to accompany me to a notary to sign it when the claim was not admissible ab-initio? Also, so far, none of the communications make that point and I’ve been given to understand that its due to the doctor’s note (which was
misinterpreted) they had rejected the claim.

I have been harassed unnecessarily due to Apollo Munich's incompetent staff who don’t know how to write nor communicate.
Please help and suggest way forward.

Regards,
Deepak Varde
**********

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