I was on my vacation trip to Kerala when I got admitted to a TTK network hospital (N.S. Memorial Institute Of Medical Sciences Kollam Kerala) on 05-OCT-2013 around 2PM due to severe fever and body pain. Through my employer – Oracle India Pvt Ltd., I was under medical insurance from TTK Health Care TPA Pvt Ltd during this period. TTK Health Care has promised cashless facility in this hospital. But there was no staff available on that day to process the cashless facility. I was discharged on the next day around 5PM. On 23-OCT-2013, I had submitted a medical claim to TTK representative, who collects the claim forms from our office. He has issued an acknowledgement receipt. I have submitted the treatment summary, medical bills, discharge summary from the hospital along with the claim. (VISWANATHAN JAYAMOHAN Emp.Id – 1907 Receipt Number – BLR/12/No:2943) Amount claimed is – INR-3,069. After a month, I checked with the customer care on the status of the claim and came to know that there is a shortfall on the documents submitted. I contacted, Ms. Vidula.K, who is the Asst manager- customer relation, on 03-DEC-2013 through my employer’s HR division. She had informed me that the discharge summary contians only the date of admission and date of discharge and does not contain the time component. Also the treatment summary is not proper in terms of the line of treatment given and presciption. I have replied to TTK that is not practical to travel to Kerala and collect the documents from the TTK network hospital in the way they want. I couldn’t even receive a proper response to my e-mail request. My complaints are – 1. TTK lists hospitals, where there is no staff to process the cashless facility and thereby denying cashless facility to a policy holder 2. TTK lists hospitals, where the staffs do not have the basic knowledge on preparing the discharge summary (they exclude the TIME, though the date is present) 3. TTK lists hospitals, where the doctors do not know how to prepare the treatment summary as per TTK expectation 4. Not processing the claim based on the documents from TTK’s network hospital

TTK should contact their network hospital and obtain the necessary details, which are absent in the discharge summary and treatment summary. TTK couldn’t provide the cashless facility in their network hospital due to their insufficient staffing. TTK should return me the yearly premium they had collected through my employer for providing this service.

Complainant Information
name- jayamohanv