{"id":1421,"date":"2015-12-03T06:52:33","date_gmt":"2015-12-03T01:22:33","guid":{"rendered":"http:\/\/ravi.rajiniravi.com\/blog\/?p=1421"},"modified":"2015-12-04T09:57:26","modified_gmt":"2015-12-04T04:27:26","slug":"never-again-to-a-fortis-associate-hospital","status":"publish","type":"post","link":"https:\/\/ravi.rajiniravi.com\/blog\/2015\/12\/never-again-to-a-fortis-associate-hospital\/","title":{"rendered":"Never again to a Fortis (associate) hospital"},"content":{"rendered":"

When a life altering moment occurs, people remember – Castle.<\/p><\/blockquote>\n

Having a baby is one such moment and you remember every thing around that event for the rest of your life.\u00a0 For many, the happenings around that moment are really happy ones. Everything except one for me was as well.<\/p>\n

This post is about that one thing which wasn’t the happy one. And that thing is the way S.L.Raheja <\/a>(A Fortis associate)<\/a> Hospital<\/a> dealt with providing cashless insurance for maternity.<\/p>\n

To cut a long story short, they f***** up big time on the way they behaved with us on providing cashless insurance for maternity.\u00a0And I guess they’d do the same with anyone looking to opt for one there. My strong recommendation is, don’t go to a Fortis Hospital if you are thinking of getting cashless facility for (some part) maternity expenses<\/strong>.<\/p>\n

The rest of this post is going to chronicle my ridiculous interactions with Fortis TPA and administration in a chronological order.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\nDay -9<\/u><\/strong>: A few days before the D-Day, we decide to go to the hospital to check and do all formalities needed for admission. Accordingly, we are directed to the counselling section to check about registration and costs.\n<\/td>\n<\/tr>\n
\nCounsellor1\n<\/td>\n\nThe counsellor explains the standard maternity packages along with estimated additional charges. The package we decide on was Rs.100k for normal delivery and Rs.125k for Cesarean delivery. She then informs us that since my wife \u2013 \u2018the patient\u2019 (I have strong reservations on the use of this word for (expectant) moms) – was already registered, we can come and do all financial formalities at the time of admission.<\/p>\n

We then mentioned that we had a corporate insurance policy that covered maternity and would like to use the cashless facility up to the extent it covered (it covered Rs.50k). The rest, we said, we\u2019ll pay promptly and as asked.<\/p>\n

Immediately, the counsellor asked about the insurance company and when we mentioned it was National Insurance<\/a>, she said, \u2018we don\u2019t accept GIPSA<\/a>\u2019 (note the sweeping nature of this statement) claims and that we\u2019ll have to pay in full ourselves and claim later. Our questions on why fell on deaf ears so we decided to go to the person who was in charge (of administration?) of the maternity ward (referred to by our Doctor) to find out more.\n<\/td>\n<\/tr>\n

\nResident Doctor\n<\/td>\n\nNear the ward, we bump into the Resident Doctor doing her rounds and who knew us well by now (a couple of rounds of consulting). On hearing about our query on insurance, she promptly calls up the Counsellor to ask, \u2018what is the problem with insurance?\u2019<\/p>\n

She then directs us to go back and speak to the Counsellor.\n<\/td>\n<\/tr>\n

\nCounsellor1\n<\/td>\n\nWe go back to the Counsellor who rolls her eyes on seeing us. After the conversation with her, we leave the place with the explicit understanding that cashless facility will be provided to us.\n<\/td>\n<\/tr>\n
\nDay 0<\/u><\/b>: It\u2019s 00:00 hrs and the D-Day has officially started. Time to get admitted and we are all excited!\n<\/td>\n<\/tr>\n
\nCashier1\n<\/td>\n\nWe go straight to the payments section, state the purpose for admission, mention the maternity package and insurance, fill the necessary forms, pay the demanded advance (Rs.10k), go to the ward and get admitted.\n<\/td>\n<\/tr>\n
\nTPA assistant1 & Admin1\n<\/td>\n\nJust after the counter opens for the day, I ask for the necessary TPA\/insurance forms and get them filled (take wife\u2019s signature, Resident Doctors note and signature etc.,). While submitting, I specifically check if they take \u2018GIPSA claims for maternity\u2019 and they tell me they do.<\/p>\n

I also notice Admin1 hanging around in the background listening to my questions on \u2018GIPSA maternity claims\u2019. This happened to be a coincidence and he didn\u2019t raise any issue then.\n<\/td>\n<\/tr>\n

\nMidday – Day 0<\/u><\/b>: It apparently takes a few hours for the TPA assistance cell at the hospital to process a single page form! And while processing, the hospital TPA assistants \u2018realise\u2019 they cannot accept it. They then call me up asking me to visit the counselling section.\n<\/td>\n<\/tr>\n
\nTPA assistant1\n<\/td>\n\nI go to check on the problem.<\/p>\n

The TPA assistant informs me that she wasn\u2019t aware of the \u2018hospital rule\u2019 that they are not supposed to accept \u2018GIPSA maternity claims\u2019.<\/p>\n

I collect my TPA forms and storm to Counselling.\n<\/td>\n<\/tr>\n

\nCounsellor2\n<\/td>\n\nCounsellor1 we met a few days ago isn\u2019t around. So, I meet Counsellor2 who point blank tells me, \u2018GIPSA claims for maternity are not accepted.\u2019<\/p>\n

When I ask for clarification, she directs me to Counsellor3.\n<\/td>\n<\/tr>\n

\nCounsellor3\n<\/td>\n\nCounsellor3 explains to me that GIPSA is not accepted by the doctors because they ‘don\u2019t make money’ due to the low claim limits.<\/p>\n

I clarify a) that I am going to pay the maternity package amount not covered by insurance when asked, b) that I already paid Rs.10k as advance at the time of admission and c) that I expect the insurance to cover Rs.50k, the maximum payable for maternity. And I further added that if they have any concerns, I\u2019ll pay an additional Rs.50k (the remaining cost for normal delivery; not including the advance) which should cover the full package cost right then.<\/p>\n

I also tell her that we\u2019ve already informed the necessary corporate person in charge of insurance who\u2019ll follow-up for prompt processing at the insurance agency end.<\/p>\n

She still asks me to pay full and claim insurance later to which I ask if it is a \u2018hospital policy\u2019 or a \u2018doctor policy\u2019 not to accept GIPSA claims.<\/p>\n

When she states it\u2019s a \u2018doctor problem\u2019, I ask her to speak to the Doctor before me because, I think, the Doctor we go to will not have a problem.<\/p>\n

As expected, the busy Doctor doesn\u2019t answer her calls. She tells me she\u2019ll inform me post speaking to the Doctor.<\/td>\n<\/tr>\n

\nCashier2\n<\/td>\n\nNot willing to take any risks, I promptly go to the cashier and pay a further Rs.50k.\n<\/td>\n<\/tr>\n
\nAn hour or so later, the Doctor comes for her visit to our room.\n<\/td>\n<\/tr>\n
\nDoctor\n<\/td>\n\nI find an appropriate time and ask her about her unwillingness to accept GIPSA claims.<\/p>\n

She informs me that she doesn\u2019t have any problem as long as we pay any shortfall on the \u2018full hospital package amount\u2019 that the insurance will not cover. I inform her that I\u2019ve already paid 50% of that amount and she tells me that cashless insurance claim is absolutely fine with her before leaving.\n<\/td>\n<\/tr>\n

\nTPA assistant1\n<\/td>\n\nArmed with this clarification, I go down to the TPA assistance desk to check on the status of my claim. She directs me to speak to Admin1.\n<\/td>\n<\/tr>\n
\nAdmin1\n<\/td>\n\nHe directs me to Admin2.\n<\/td>\n<\/tr>\n
\nAdmin2\n<\/td>\n\nAdmin2 gives me the story of \u2018Doctors not accepting GIPSA\u2019. I clarify again that I\u2019ll pay whatever the insurance doesn\u2019t cover in the package and show her the 50% payment I already made (which should cover for any shortfall).<\/p>\n

Having lost my patience, I now demand to speak to someone really senior at the hospital about this matter. She informs me that she\u2019ll come back.\n<\/td>\n<\/tr>\n

\nPost noon – Day0<\/u><\/b>: Looks like things on this GIPSA front have settled now. My wife’s labour pains have started and just when we are looking forward to the next few hours, the TPA assistant calls and asks me to fill another form.\n<\/td>\n<\/tr>\n
\nTPA assistant1\n<\/td>\n\nThe assistant hands me an additional form, asks me to fill and submit it.<\/p>\n

This form was essentially a declaration letter to the hospital which stated that I have financial problems and hence cannot pay the bills (not the exact words but something to that effect)!\n<\/td>\n<\/tr>\n

\nAdmin1 &
\nAdmin2\n<\/td>\n		\nFurious, I storm into the billing office and ask them about why I need to fill that ‘declaration’ when I already paid quite a bit.<\/p>\n

They explain that it\u2019s the only way out to accept \u2018GIPSA claims\u2019 at their end.<\/p>\n

I tell them that I\u2019ll not sign such a ridiculous letter and demand to speak to that someone really senior at the hospital and leave the hospital to have lunch.\n<\/td>\n<\/tr>\n

\nSometime in the afternoon – Day0<\/u><\/b>: The Doctor calls my wife (she doesn\u2019t have my number) to tell that she\u2019s been getting pestering calls from the counselling office and requests me to solve this issue.<\/p>\n

A few minutes after that, CounsellorX (I don\u2019t know who it was exactly as I wasn\u2019t around) visits the room my wife was in and asks us to pay ourselves and not claim cashless insurance.<\/p>\n

My wife, half in labour, who was very well looped into the nonsense happening on this front (and on whose corporate policy, we wanted the claim done) asks her why? Hearing the ridiculous \u2018doctor problem\u2019 story the Counsellor tells her again, she loses it and shouts at her.<\/p>\n

The counsellor realises my wife\u2019s condition and leaves noticing her trembling in anger.\n<\/td>\n<\/tr>\n

\nLate afternoon \u2013 Day0<\/u><\/b>: I come back and help calm my wife down. Not hearing anything more on the payment front, we settle into a routine of timing her contractions.<\/p>\n

Unfortunately, the duty doctor realises that there is a slight complication and advises us to go for a Cesarean section delivery. We agree.<\/p>\n

The duty nurse hands over a form to me and asks me to get it signed by counselling and submit it to billing. The form is essentially a clearance of dues for Cesarean delivery. Once done, the doctor and patient can proceed to the operation theater she states.<\/p>\n

By now completely frustrated by the counselling, TPA and admin teams, I decide to pay the bills myself and claim the insurance later.\n<\/td>\n<\/tr>\n

\nCounsellor1\n<\/td>\n\nMe: You need to sign this. I don\u2019t want to do cashless insurance. Let me know how much I need to pay. I\u2019ll pay it immediately.<\/p>\n

Counsellor1: How much did you pay already?<\/p>\n

Me: [in my mind \u2013 you are supposed to know this dammit!] 50k + 10k advance.<\/p>\n

Counsellor1: [opens the maternity package details, confused with the calculations] You don\u2019t have to pay anything now.<\/p>\n

She then signs the form and hands it to me.<\/p>\n

Me: Thank you.\n<\/td>\n<\/tr>\n

\nI then proceed to the cashier, hand over the form to him and ask him to expedite whatever he has to do on it.<\/p>\n

A couple of hours later, I pay another Rs.5k as advance for the baby.\n<\/td>\n<\/tr>\n

\nTwo days later, I pay another Rs.67.6k to settle all dues thus paying the full hospital charges myself and not claiming cashless insurance via the hospital.\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Walking out of that hospital. I decide not to visit it another time.<\/p>\n","protected":false},"excerpt":{"rendered":"

When a life altering moment occurs, people remember – Castle. Having a baby is one such moment and you remember every thing around that event for the rest of your life.\u00a0 For many, the happenings around that moment are really happy ones. Everything except one for me was as well. This post is about that […]<\/p>\n","protected":false},"author":1,"featured_media":3979,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"book_review_cover_url":"","book_review_title":"","book_review_series":"","book_review_author":"","book_review_genre":"","book_review_isbn":"","book_review_publisher":"","book_review_release_date":"","book_review_format":"","book_review_pages":"","book_review_source":"","book_review_rating":"","book_review_summary":"","_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[95,6],"tags":[],"class_list":["post-1421","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-30-day-challenge","category-rambling"],"jetpack_featured_media_url":"https:\/\/ravi.rajiniravi.com\/blog\/wp-content\/uploads\/2021\/01\/photo-1547139559-c89c59d117611.jpg","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/posts\/1421","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/comments?post=1421"}],"version-history":[{"count":9,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/posts\/1421\/revisions"}],"predecessor-version":[{"id":1430,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/posts\/1421\/revisions\/1430"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/media\/3979"}],"wp:attachment":[{"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/media?parent=1421"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/categories?post=1421"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ravi.rajiniravi.com\/blog\/wp-json\/wp\/v2\/tags?post=1421"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}