REJECTION:- Dated 12.5.2015 Indraprastha Apollo Hospitals Sarita Vihar Mathura Road, New Delhi Sub: PreAutorization Repudiation Letter Hospitalization of Ms.Veena Seth Policy No. 52146199 Membership No. RLC4U038513X PreAuth No. 242673 Estimated Cost Rs.404000/- Admission Date 18.5.2015 Expected Discharge Date 28.5.2015 Dear Sir/Madam It is unfortunate , but we regret to inform you that , as per the instruction of the insurer, Reliance Life Insurance Company Limited, the cashless payment is being denied and thus not payable under the rules guiding the policy. The member was enrolled from 26/3/12.The member was suffering from DM,HTN,Heart disease since 2012.Present ailments are complication of DM,HTN,Heart disease. The claim for the ailment in question falls within the four year waiting period specified in the policy . Hence the claim is not admissible & not payable. HENCE THE PREAUTH IS NOT PAYABLE Please note that the above-mentioned reasons for declining your request for availing of cashless facility have been mentioned and adjudicated based on certain preliminary treatment documents . However the denial of authorization for ‘CASHLESS’ access does not imply denial of treatment and does not in any way prevent you from seeking necessary medical attention or hospitalization.The Customer / beneficiary can however come back for reimbursement with all necessary documents for review. our statement:- As per the rules and regulations specified in the clause number 5.5, the valve replacement of the heart is done after the completion of 3years of policy but in the present situation the entrepreneurs has rejected our policy even after the renewal for 4 continues years. The reason stated for the rejections seems to be redundant because the valve rupture can be due to various other reasons and not only due to hypertension as stated by the authorities rather the situation is vice a versa the HTM is due to the incompetent valve of the heart but how ever our case stands for the replacement of valve and not for the treatment of HTM and DM thus in accordance to the section 5.5 of the policy our case stands.

Insurance claim- rs 230000 mental disturbance caused by the company-rs 270000

Email Id: vikasseth8@yahoo.