- Incorrect Claim Amount appproved ^Closed

Neel Sinha filed this complaint against ADITYA BIRLA CAPITAL PVT LTD on Oct 06, 2023

Sharing my ordeal below

*. I took my father for an angiography on **th Sept ****. Since Angiography is a day care process, we were advised to get him admitted.

*. We initiated the Cashless hospitalisation process with Aditya Birla Health Insurance - the intital approval came the *nd day by when my father was diagnosed with **% blockage in his arteries and we had to go for angiography.

*. He was moved to general ward of the hospital for the *st night and I specifically asked the hospital to move him to a Twin sharing room after Angioplasty the next day. Hence, all estimates were shared with me accordingly.

*. The treatment done by the doctors at FMRI was commendable and I would like to appreciate Dr Rohit Goel and his team for it.

*. On the day of discharge, I was informed by the hospital that the formalities will be done by **.**AM and we could get him discharged, however the Discharge summary was shared by hospital to TPA department after **.

*. TPA department then shared all details with Aditya Birla by **.** PM and they approved the claim by *.** PM. I was not informed of the approved amount till then since Aditya Birla was facing issues with their server and the Letter was not generated at their end.

*. I called Aditya Birla team atleast *-* times and they kept asking me to wait ** mins every time to get the Letter generated.

*. I spoke with a Vivek who was a Senior person at Aditya Birla and he assured that if the Letter is not generated by * PM, he will send them over manually so the discharge could be processed.

*. The process which should have been completed max by * PM, got stretched to *PM.

**. On receiving the Approval letter, i realised there was a difference of around **k in the approval amount.

**. Bill amount was *,**,***. Amount approved by Aditya Birla was *,**,***. I was asked by the hospital to pay **,*** of which **,*** was already paid from my end during admission.

**. On chekcing with Mr Vivek from Aditya birla on the difference in approval amount, he said, sir it's already been too delayed. If you can pay the amount, please do so and we will raise a query for the difference amount later. Hence, I paid the difference amount to the hospital and got the discharge process done.

**. Later, the next day on seeing the approval amount, I realise it was mentioned in the approval letter that the amount approved was *,**,*** only however the insured needed to pay the hospital only Rs ****.

**. On asking the hospital as to why they charged additional amount from me, they said Aditya Birla only approved *.** L and the remaining amount had to be paid by the patient. However, Aditya Birla now says the patient needed to pay only Rs ****.

**. I asked the hospital TPA team to coordinate with ADitya Birla team but to no avail. I was literally left stranded by both the hospital TPA and the Insurance company after I paid the amount.

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