*Post script (22-02-2007): following my innumerable emails to icici lombard and letters to the md of ttk healthcare, there appeared light at the end of the tunnel. On 9-2-2007 my claim was reopened, a doctor from ttk called me and i explained the case, on 15-2-2007, most of my claim i.e. 29, 912 was sent to me which i received yesterday 21-2-2007.
I have changed the product rating from poor to average, as i finally got the money. But the amount of correspondence and stress i have undergone to get the expenses reimbursed is not funny. This should not be the case. Any rightful claimant must get reimbursed otherwise what is the use of taking medical insurance?
And cashless must be our right if we go to a network hospital. Their voucher sent with the cheque states ’take cashless for convenience’ (to add salt to my wounds!) - dear ttk, we would if you would approve it. We don’t want the stress of filing claims for reimbursement!!!
now read on for my experience...
First some important rules, which I am learning in hindsight. You can learn from my experience!
Do not buy any medical insurance from any company which has ttk healthcare for a tpa (third party administrator)
Do not buy any insurance online as then you will not have any agent you can hold responsible and chase in case of a claim (also do running around for you), but only faceless customer service numbers and useless emails who will only give you standard replies that request is forwarded/being looked into.
Now for the story (my stressful high BP causing experience with TTK Healthcare)...
I committed the cardinal sin of buying Medical Insurance from ICICI Lombard online in July 2006. A few weeks later, a nice policy reached home with two cards which could be used for Cashless Hospitalisation (oh how I laugh when I hear these words now... this term is a joke!). The TPA was TTK Healthcare. I thought ’how professional’.
Now I never expected to fall sick in the first year of taking medical insurance! In December, I started getting high fever. A few days later, it was diagnosed as Hepatitis. Due to increasing serum bilirubin levels, I flew down to Mumbai at my cost (from Lucknow where I work) and was admitted to Hinduja hospital on the same day. (Note: HINDUJA IS A TTK NETWORK HOSPITAL.)
My father was pleased to find a TPA desk (why bother?) in the hospital lobby. They very kindly gave us a form for request for cashless hospitalization approval from TTK (did we miss a smirk on their face?) and next day my father (66 years old) went to the trouble of filling the form, getting doctor’s signature and xeroxing previous reports of Liver Function Test and USG done in Lucknow and getting it faxed by the TPA desk to TTK..
To our surprise, there was a request for additional details. We got this filled too by the doctor where it was mentioned that the diagnosis is Hepatitis A. Again this was faxed along with some 20 pages of reports from Hinduja (my father had to run around getting xeroxes and for faxing again!)
Now we got the shock… After following up, we got to know on the day of my discharge that the Cashless Claim had been rejected!!! Now my father had to run around to collect cash for paying the hospital.
The surprising thing was that they failed to mention the diagnosis, still asking for details… (God knows what details these guys want) The level of customer service is abominable… they did not bother to speak to us for any clarification or confirmation. They treat genuine patients as if they are out to cheat the insurance company. They fail to comprehend and understand that someone is ill and suffering and paperwork is not the top priority for the family members. Even then all hospital papers have been submitted!
But more was to come. A week later, I and my father hired a car and went to file a claim for reimbursement. TTK took all the original papers along with the claim form.
In the interim, numerous calls to ’Customer Service’ and emails are also answered by standard replies - ’being forwarded to the department for further action’, etc.
Two week later I receive a letter sent by ordinary post (not registered post, not courier - so if it is lost in transit, more the delay!) saying that there is a ‘shortfall’ (don’t you just love their terminologies!) and "previous consultation papers are required since fever first detected."
Since all original papers of doctors and tests in Lucknow were already submitted (and for which I was not claiming a penny), we were at a loss as to what they wanted.
So I sent a letter explaining that the two consultation papers of two doctors in Lucknow and all tests done in Lucknow were already submitted in original in the file.
But to no avail… (what TTK Healthcare wants to do is to harass and not pay genuine patients) so after another week, the file is closed completely ignoring my letter.
Subsequently on speaking with friends and colleagues, I have realized that many people have faced the same problem. The terminology is always the same:
Pre-existing condition (Dear Insurance companies, then why do you give insurance cover without a complete check-up)
Previous consultation papers not submitted (I believe we will have to keep all papers right from the first BCG given at birth if any TPA is to pay any claim in India)
So much for Medical Insurance… I feel that this farce of Medical Insurance has added stress and mental tension and increased the effect of my illness! If there was no Medical Insurance and no expectation and no harassment from TTK, I would have forgotten the illness and got on with my life. As it is I am wasting time calling up TTK, sending letters to TTK’s MD and writing this review!
So I have learnt from my experience –
NO MORE MEDICAL INSURANCE
TAKE WHAT TREATMENT I CAN AFFORD, AND NOT BE UNDER ANY ILLUSION OF CASHLESS HOSPITALISATION / REIMBURSEMENT
STAY AWAY FROM ICICI LOMBARD AND TTK HEALTHCARE
STICK WITH GOVERNMENT OWNED LIC
START A SEPARATE RECURRING DEPOSIT / SIP WITH A GOOD MUTUAL FUND FOR A BACK-UP FUND FOR MEDICAL EXPENSES AND NOT TO DEPEND ON FARCE OF A MEDICAL INSURANCE
There are also other stories, which I found when I searched the net. I hope my story will now encourage others to share their experiences and expose Medical Insurance in general ICICI Lombard and TTK Healthcare in particular.
To end, I can only thank god that I learnt the truth about Medical Insurance with a wrongly rejected claim of just Rs.32, 000/-. I don’t know what would have happened if it had been something more serious like a heart attack or worse with a claim of lakhs of rupees being rejected... (SEE POST SCRIPT AT BEGINNING AS THIS HAS BEEN CHANGED NOW)
It appears that TTK stands for ’Torture To Kill’...