We are senior citizens aged 76 and my wife 73 now residing at Coimbatore. We are cancard (credit card) holders since 1989-90. Initially the underwriters were National Insurance, then New India Insurance and now United India at Bangalore. Their Third party Administrators are E-Meditek, Bangalore. Now this TPA is not cooperating with the insured. They make lot of questions bit not settling the Mediclaim insurance for reimbursement against Surgeries. Even though they are having cashless treatment with many hospitals, the hospitals are not allowing us for cashless treatment saying the TPA is not reimbursing the amount to them in time and disallowing lot of expenses under one pretext or other. When we pay money and file our claim bills with supports they ask so many clarifications but reimburse only 60% amount spent. When we ask for reasons they don't reply. Why this anamoly. When we seek consumer Association people at Chennai they inform the concerned person is not answering and advise us to contact IRDA people. Is there any solution for getting actual claim from underwriters. United India is not accepting any thing but simply collecting premiums. What is the remedy for Senior citizens as we are paying around Rs. 17,500/- per annum for two of us? Anybody can help on this score. more
Viewed by 372
View all 13 comments Below 13 comments
"Chennai Consumer Forum is not taking up the matter" you can approach to the State Consumer Commission. As Sr. Citizen you must also entailed for Preference in listing, expediting and hearing, so also as "Medical" more
Aug 19
Sir, Before going to any action please read the details given in your policy carefully Even i experienced the same way as you are but i pay my premium directly to united india insurance and they have a third party. Yes they deduct some amount but not 40%. when they are responding as you are very senior citizen, please ask any friendly advocate by giving a small fees give a notice and file your case in local court . some where i read even in courts also senior citizens and retired people cases are to taken on priority bases. Perhaps some advocated on this forum may help us. more
Jul 26
It is not understood why Chennai Consumer Forum is not taking up the matter.After a formal complaint is made as per their rules the are to summon the parties just like a law court and made hearings and then decide their judgement. They cannot say the party against whom a complaint is made is not giving response. If it it doesn't response the Consumer Forum can give exparte judgement after going through its procedures. more
Jul 24
E-Meditek is the worst TPA. It harrasses& humilate the customers by raising filmsy objections. IRDA don't take any action. One has to go for litigation to have small dues. Insurance Ombudsman takes years to settle the dispute. Some drastic reforms are needed. We all should request the Government by using social media. more
Jul 24
sir, do you have any experience with ombudsman If so please mention about your experience more
Jul 26
