[docsr]

My 78 year old mother travelled to the US in July last year. She is otherwise fit and has no significant active medical issues. Unfortunately, during the trip, she suffered some minor injury and developed swelling in her right hand. This required an emergency room visit and emergency surgery 2 days later. She was in the hospital for 2 days. Fortunately, the entire process and care was cashless-and she recovered well.She was told that the hospital would be sending the bills over the coming weeks.
Prior to her travel, we had purchased International Travel Insurance from Bajaj Allianz via their online portal. The coverage was for $100,000. I learned that they are tied up with United Health in the US.
She returned in October. on returning, bills from the hospital began coming in. Were instructed to foward all the required documentation to Bajaj Allianz for payment. Then the saga began.

For the next 2 months, they kept asking for document after document-from surgery she had undergone in 2018 and more. Every time we sent the required document, there would be a long silence. We would try getting to them, and when we eventually did, they would ask for more documents-some for the second/third time. This went on for 3 months.

Now they have emailed saying that the claim has been refused. The reason that they have provided are flimsy at best.

This has caused us great distress. The amount due to the US hospital is HUGE.about 20 times what a similar procedure here would have costed (even in the fanciest of corporate hospitals).

I sincerely think the if there were fair grounds to reject the claim, they would have done it early on in the claims process. This whole process of dragging it out for 2-3 months leads me to believe that they were looking for reasons to reject the claim.

We are in the process of writing to the Insurance Ombudsman.

I am writing to ask of others have has such experiences and how I should proceed with this. What recourse to we have? IRDA, Consumer court?

Any advice or assistance would be greatly appreciated.

Regards.

[Agarwal_Aayush]

You can call their customer support team and tell them if they do not give any proper reason for declining your claim you will approach IRDA to file a complaint.

Also, raise your concern on social media platforms, these companies do not like negative publicity and will try to resolve your issue at the earliest.

If you have time in your hand, visit their office and talk to them face to face.

if these do not work, mark an email to IRDA keeping the grievance redressal team of Bajaj Allianz in CC.
You will for sure start getting calls from them and you will reach a resolution soon.
That is the only way you can make them listen to you.


Thanks,
Aayush

[Way2Jimny]

Originally Posted by docsr

We are in the process of writing to the Insurance Ombudsman.

I am writing to ask of others have has such experiences and how I should proceed with this. What recourse to we have? IRDA, Consumer court?

Regards.

If the reasons are genuine , Ombudsman will be favorable to you. Once you raise a complaint to Ombudsman, they will send an email to the lawyer of your insurance company. In most of the cases, the lawyer will advise insurance company to resolve it amicably.

[UD17]

Originally Posted by docsr

Mwe had purchased International Travel Insurance from Bajaj Allianz via their online portal.

This is great point of concern, as i (& my full staff) always buys the travel insurance policy with Bajaj allianz, although through our office travel agent.

I will contact our agent & try to get some info on claim process and the reasons why Bajaj might reject the claim. If i manage to get any useful information, i would post it here. But for sure in future, i would ask for other options from them other than Bajaj.

[hema4saran]

United health and Bajaj allianz both are for no good. Try to get this cleared through IRDA. But in general the US hospitals don't have a way of claiming the amount from a tourist (No SSN to track the person). Most times the bills will go into collections and eventually written off (another reason why healthcare costs are so high).

If the ombudsman is not able to settle the issue, you can try contacting the phone numbers in the bills received and explain to them what happened and request them for a one time settlement. If one time settlement is also huge amount, then you just leave it as it is. Most likely result will be your mother won't be able to renew her B1/B2 visa next time (rare case scenario) since they don't report this to state department unless until the charges are criminal.

Off Topic. (Delay, Deny & Defend) is famous phrase used few by insurance companies here.

I will tell a funny scenario faced by a good friend when his mom visited him. She had a food poisoning here and took treatment. The visitor insurance company denied it saying it is pre existing condition. He sent the denial letter to both hospital and insurance company asking them to explain how food poisoning is pre existing condition. He was not given proper answer from either of them. Finally the hospital relented and settled for an amount less than $300.

[docsr]

Hello, here is a follow up. Matter still remains unresolved.
We were asked to write to the grievance officer at BajajAllianz as an additional step before approaching the ombudsman.
We were enthused to find a grievance officer specifically for senior citizens-with a mention that there will be a reply in 2 weeks. Well, it is one one month now, and we are still waiting. With great difficult , also found a nodal officer for this region and spoke to him as well.
Will wait for a couple of more days and then approach the ombudsman.

The hospital portal still says case pending with insurer (United Healthcare). There is a bill for a smaller amount, for a ER visit that has become due and there has been a letter from what appears to be a collections agency.

While we can pay this, we are being instructed by acquaintances in the US , not to pay anything personally.

So the matter festers.

[Turbanator]

Originally Posted by docsr

While we can pay this, we are being instructed by acquaintances in the US , not to pay anything personally.

Most Indian insurances for overseas are Junk. I will only go with a reputed insurance provider of that country (say Manulife for Canada). These cost maybe 10 times more but are worth the extra, in my opinion.

Perhaps you need to mark a copy of your communications to the hospital/ collection agent and also separately to the Hospital stating your inability to pay as you were covered under Insurance, and they should try to recover directly. Try best to make Bajaj pay, as otherwise, it will only add to some other fellas getting in trouble. I think, by default, US hospitals do not hold treatment in urgent cases, but who knows if they also become like ours, asking clear approvals before starting treatment.

[BoredBonnet]

This is scary and I keep seeing similar experiences on LinkedIn / Twitter.

Any guidance on travel insurance for Singapore please? Or in general, any aggregator website showing all foreign providers.