- BILLING FRAUD BY MAX HOSPITAL SHALIMAR BAGH ^Closed

AKHIL JAIN filed this complaint against Max Hospital on Oct 05, 2020

MY FATHER MR. MADAN LAL JAIN {IPID ******}, MAX ID {SHBG ********** } WAS ADMITTED IN MAX HOSPITALS SHALIMAR BAGH ON ** AUGUST **** FOR TREATMENT OF COVID AS HE WAS FOUND POSITIVE ON ** AUGUST **** .ON ** AUGUST **** SINCE HIS BREATHLESSNES ARISED HE WAS SHIFTED TO HDU OF MAX HOSPITALS, HE WAS TREATED FOR APPROX ** DAYS IN HDU AS HIS ILLNESS HAD BECAME CRITICAL.NOW BY ALMIGHTY GODS GRACE ON ** OF SEPTEMBER HE WAS SHIFTED TO NORMAL WARD ROOM FROM HDU AS DOCTORS SUGGESTED THAT HE IS BETTER NOW AND NO NEED FOR OBSERVATION IN HDU. FINALLLY THE DAY CAME AND DOCTORS DECIDED TO DISCHARGE HIM FROM HOSPITAL. I AM REALLY THANKFUL TO WONDERFUL TEAM OF DOCTORS ,SPECIALLY DR. VANDANA BOOBNA AND DR. SANJAY DHALL.

DEAR SIR,
I HAD A MEDICLAIM POLICY WITH STAR HEALTH INSURANCE POLICY NO. P/******/**/****/****** COMPANY FOR INR * LACS AND SOME NO CLAIM BONUS ATTACHED. WHEN INITIALLY WE WERE ADMITTED IN HOSPITAL WE WERE NEVER TOLD BY HOSPITAL THAT COVID TREATMENT CHARGES UNDER CASHLESS FACILITY AND UNDER CASH {AS PER GOVT. TARIFF} ARE MAJORLY DIFFERENT, ALSO WE DIDN'T KNEW IT WILL TAKE SO MANY DAYS AND I WILL HAVE TO PAY SO MUCH OF AMOUNT .
NOW AT THE TIME OF DISCHARGE MAX HOSPITALS GAVE ME TOTAL INVOICE OF APPROX **,**,*** .WHEN I GET TO KNOW THAT MY TOTAL BILL IS **,***** ,IT CAME TO MY MIND THAT EVEN THOUGH I AM GETTING ****** FROM INSURANCE COMPANY{INCLUDING NO CLAIM BONUS} I STILL HAVE TO PAY APPROX ****** FROM MY SAVINGS.

THEN I ASKED THE HOSPITAL THAT IF I WOULD NOT USE THE CASHLESS INSURANCE WHAT WILL BE MY APPROX INVOICE ACCORDING TO DELHI GOVT TARRIFF FOR COVID-** TREATMENT, THE HOSPITAL AUTHORISED PERSON MEENAKSHI RAJANI TOLD ME THAT IT WOULD BE APPROX *,**,***. I THEN DECIDED THAT I WOULD NOT AVAIL CASHLESS FACILITY FROM INSURANCE COMAPANY, I WILL GO WITH GOVT TARIFF AND WILL PAY THE WHOLE AMOUNT ****** FROM MY POCKET AND WILL SAVE THE INSURANCE POLICY FOR FUTURE USE AS DOCTORS TOLD ME THAT MY FATHERS CONDITION IS NOT STILL STABLE AND SATISFACTORY .. HE MIGHT GET ANY OTHER PROBLEMS AS WELL IN NEAR FUTURE {SINCE HE IS COVID RECOVERED} SO I DECEIDED THAT SINCE NOW MY FATHER WAS ADMITTED UNDER COVID TREATMENT I WANT TO TAKE THE BENEFIT OF GOVT. COVID TARIFF.

I INFORMED HOSPITAL ADMINISTRATION WITH AN EMAIL { SCREENSHOT ATTCHED WITH THIS EMAIL} THAT I WILL NOT AVAIL THE CASHLESS INSURANCE CLAIM AND WILL PAY WHOLE AMOUNT FROM MY SIDE .. OUT OF WHICH I HAD ALREADY DEPOSITED * LACS FROM MY SIDE IN THE PREVIOUS DAYS AS TIME TO TIME DEMANDED BY HOSPITAL. AFTER HALF AN HOUR AFTER GIVING INFORMATION TO THE HOSPITAL I WAS WAITING FOR THE INVOICE FROM HOSPITAL { AS PER DELHI GOVT TARRIF} I GOT A CALL FROM ADMINISTRATION COUNTER THAT MY PROPOSAL FOR GETTING GOVT TARIFF HAS BEEN DENIED BY THE HOSPITAL ADMINISTRATION. I REQUESTED, {THE AUTHORIESED MANAGERS , SHWETA MUTHREJA, AND MR PANKAJ} THAT AT THE TIME OF DISCHARGE U CAN NOT DO THAT , BUT THEY NOTICED THAT I WAS IN HURRY .. SO THEY TOOK BENEFIT OF THE SITUATION AS IT WAS ALREDY * PM . THEY CLEARLY DENIED MY REQUEST AND TOLD ME THAT ITS A CORPORATE DENIAL AND ITHEY CAN NOT DO ANYTHING ABOUT THIS AND WE CAN NOT GO OUT OF HOSPITAL UNTIL I CLEAR THE HOSPITAL BILL OF *******.

AND EVEN WITH OUT MY CONSENT THEY SEND ALL DOCUMENTS AND CASE SUMMARY TO THE INSURANCE COMPANY AND GET THE FINAL APPROVAL AMOUNT OF ****** ,WHERE AS I GAVE THEM THE APPLICTAION LETTER THAT IN NAME OF STAR HEALTH THAT I DNT WANT TO AVAIL CASHLESS FACILITY AT THIS MOMENT ,WHICH WAS STAMPED AND RECEIVED BY HOSPITAL ADMIN. {COPY ATTACHED} I WAS REALLY FEELING LIKE ROBBED AND AT THAT TIME NO ONE WAS READY TO HELP ME.

MY MAIN CONCERN WAS THAT I HAVE USED WHOLE OF THE INSURANCE AMOUNT AND ALSO PAYING * LACS APPROX FROM MY POCKET, IF IN NEAR FUTURE MY FATHER REQUIRE HOSPITALISATION WHERE WOULD I GET MONEY FROM AS MY INSURANCE IS EXHAUSTED AND MY SAVINGS AS WELL, I CELARLY TOLD ALL THIS SITUATION TO HOSPITAL ADMIN BUT ALL IN VEIN NO ONE WAS READY TO HELP ME IN THAT.
FINALLY I PAY ALL THE AMOUNT AND GET MY FATHER DISCHARGED.IN THE END WHEN I ASKED THE AUTHORISED PERSON TO GIVE ME THE CORPORATE DENIAL REASON IN WRITTEN HE CLEARLY DENIED TO THAT , THEY CANT GIVE ANYTHING LIKE THIS IN WRITTEN.

NOW I WANT TO ASK THE HOSPITAL AUTHORITIES
*.WHERE IT IS WRITTEN THAT I CAN NOT DENY THE INSURANCE CASHLESS FACILITY.
*.WHY DID THE THE HOSPITAL NOT CHARGED AS AS PER THE GOVERMENT COVID-** TARIFF.
*. WHY DID THEY SENT THE APPROVAL DOCUMENTS TO STAR HEALTH EVEN WHEN I GAVE
THEM IN WRITTEN THAT I DNT WANT CASHLESS FACILITY.

THIS IS JUST GREED OF MAX HOSPITAL WHICH MADE ME PAY APPROX * LACS EXTRA.
ME AND MY FAMIILY WERE FEELING HOPELSS AND WITH THE MENTAL HARAASEMENT GIVEN TO US BY HOSPITAL ADMINISTRATION.
THIS IS MY REQUEST KINDLY RESOLVE MY ISSUE ASAP.
I AM GOING TO TAKE THIS MATTER FURTHER OTHERWISE.
THIS IS CLEARLY THE CASE OF ROBBING AND TAKING ILLEGAL BENEFIT OF SITUATION.

PLEASE NOTE: INVOICE ACCORDING TO HOSPITAL TARIFF IS **,*****
SAME TREATMENT , SAME FACILITIES, SAME HOSPITAL AS PER GOVT TARIFF IS *,**,***

WHY WOULD I BEING CHARGED ****** EXTRA.

ATTACHED: *. HOSPITAL INVOICE *. ADMISSION SUMMARY
*. REQUEST LETTER TO STAR HEALTH FOR NOT AVAILING CASHLESS FACILITY, WHICH IS INFACT BEING RECEIVED AND STAMED BY HOSPITAL ADMIN.
*. EMAIL TO HOSPITAL { BEFORE GENERATION OF INVOICE BY HOSPITAL} INFORMING THEM THAT WE ARE NOT GOING FOR CASHLESS AND WE WILL PAY THE WHOLE AMOUNT CASH.

DEAR SIR IT IS MY HUMBLE REQUEST TO RESOLVE THIS ISSUE .. IF THE AUTHORITIES SAYS THAT WHATEVER HAS HAPPEND IS JUSTIFIED I WILL TAKE MY STEP BACK . BUT IF IT IS NOT JUSTIFIED PLEASE REFUND ME MY AMOUNT AND COMPENSATE WITH THE MENTAL HARASEMENT GIVEN TO MY FAMILY IN THE DAY OF DISCHARGE

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