September 16th, 2015

I still am not sure whether the woman at baby memorial hospital insurance desk is impossibly incompetent or if the hospital is trying to fleece us.
My father was hospitalized for a few days with a small complaint. We picked BMH as it was in the network hospitals list for my insurance. Unfortunate.
1. First they insisted we had to first complete the admission process by paying Rs 10000 cash, and only later can they inform insurance TPA. When asked why, it was a partly refundable Rs5000 for non-insurance expenses. Fair enough.
2. Now came the insurance request. After submitting all the documents, the woman at the insurance desk just wouldn’t send a request to the insurance agency. I needed a ticket number to check up on it, but she kept insisting that the ticket number will be generated only after claim is approved. When in fact, ticket number is generated immediately after you upload the request and is part of the automated reply to your request. However, she just wouldn’t budge. Apparently she had sent the request and there’s nothing called a ticket number! So the next day I forwarded an e-mail to the hospital customer service from the insurance TPA confirming that no request ever came from the hospital. Then she moves her ass and uploads the documents. The reason she gave — ????? ?????????.. The email didn’t go. So that was the first hurdle. Getting the hospital to actually request for insurance.
3. Then came the pre-approval thing.The pre-auth was approved for 40000, and I got an email from insurance TPA with the pre-auth letter. The woman said pre-auth was approved for 32000. She kept insisting on the amount, and at last when confronted with the letter, it was -sorry, my mistake. By now, we don’t think it is a mistake at all.
4. When being discharged, I call up the insurance guys and confirm the approved amount and the co-pay share. After a day, again she calls. Please come back to the hospital and pay 8000 more. The insurance company is paying 8k less than what was told previously. So again I call up the insurance people and confirm the amount. We have paid up in full, and they aren’t paying any less.

So now the question is, what exactly are you upto? Is she just really really bad at her job? Or do you as a hospital doesn’t want to encourage cashless hospitalization?
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That’s what I posted on FaceBook about the insurance fiasco we faced at baby memorial hospital. This was very stressful for my family and me. Through a friend who forwarded it someone he knows at the hospital, a get reply that “not our fault and you should be going after the insurance company”. So I called up the number I got through the facebook comment and my version of payments are correct. They said the letter from insurance company came 15 minutes after we called you up and demanded that you drive back 50kms to the hospital very next day to pay the money. I believe the hospital doesn’t want to encourage cashless insurance claims, and they have a really bad employee on top of that. The takeaway remains. It is not easy or straighforward and has been at times full of it. If we had paid the 8000 then what? I guess that’s what people would normally do. In my case I had access to a insurance representative being a corporate insurance and I asked for stuff. And I had contacts on fb. I wonder how my sister who has an individual insurance she herself pays for will fare if she ever has to go for an insurance claim. The comment from hospital about i should be going after the insurance company instead of BMH – the insurance company has been consistent and communicative and treated me as their client. The hospital on the other hand stonewalled every query an been considering me a fool.

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