सोमवार, 23 मार्च 2015
रविवार, 22 मार्च 2015
Letter to SAIL Chairman to expedite resolving Retirees issues
Sri C.S. Verma,
Chairman , SAIL
Our several communications have gone in vain as we were not called by SAIL for a discussion on various issues concerning us. I am sure the formulation, negotiation and implementation of SAIL Mediclaim Scheme must be in the last stages but we have not been called for consultation yet whereas we will be asked to pay 15% of the contribution for SAIL's unilateral, illegal and unethical decisions. We have already intimated several times that the scheme is poorly run as it has lot of loop-holes and the Insurance Co. and the TPA do not appear to be bound by the Guidebook / Scheme circulated by SAIL. Latest of our suggestions on the Healthcare Issues and List of Hospitals to be added can be seen in http://sailex.blogspot.in/2014/12/letter-to-director-to-expedite.html
The Scheme for the period from April 01, 2015 is not circulated yet though the last date for the present Scheme is just a week away. Notification, payment and making it effective for members run into months every year. In spite of our Resolution and suggestion last October SAIL machinery could not be geared to complete the process by the end of the current term. It will leave the Retirees helpless during the long transition period as the Scheme will not factually be in effect for the Insurance Co. and the TPA and the Retirees/ spouse will be left to fend for themselves. Smooth Cashless IPD treatment is next to impossible even with lots of hassles around in the intervening period. Our suggestion is that a provision of grace period is made in the agreement, as also, with the present level of high speed communication technology, the updating at the TPA end should be automatic as and when the payment is made.
We have also come to know that the list of OPD Hospitals is prepared by SAIL. We fail to understand the rational behind this approach but, for sure, this has been creating problems in the past. The difficulty is that once a Member/ spouse visits OPD and is advised IPD treatment the uncalled for expenses increase/ gets almost doubled if a Hospital from the IPD list is visted. One way to remove the ambiguity is to enlist all Hospitals for Cashless/ IPD to be in the OPD list too.
As we have said in the recent past the TPA, under the direction from the Insurance Co., changed the limit of OPD charges to Rs. 1000/- and Rs. 2000/- for this quarter against Rs.4000/- and Rs.8000/ circulated by SAIL. It is not a good shine that SAIL never came up to correct the reverses by the TPA and the TPA continued to have an upper hand the Insured Retirees remain confused to this day. Such a circular for amending the contents of the Guidebook must come from SAIL, not the Insurance Co. and the TPA and that too not by a circular by one to one communication.
A serious issue is the delay in approving the entry of a sick insured retiree into a Hospital for Cashless treatment and also at the time of post-treatment release. Also in case of reimbursement to members by the TPA it is months and months together to the extent that one of our members Sri Asit Nandi of IISCO had to take to suicide out of shame for non-payment to his friends and relatives. We hope there will be clauses providing time limits and penalties for not adhering to them.
Large number of cases have also been reported of the mid-way derecognition of Hospitals during the period of effect in the past which we kept forwarding to you. Such arbitrary action landed the sick Insured Retiree from Cashless to Reimbursement procedure. The problems arising out of this change, in between, for the sick and aged can easily be imagined. It must be making more of Asit Nandi type suicide cases which we may not be aware of. Our suggestion is that the TPA must be asked to include in their Agreements with the Hospitals at least one month time gap for derecognition both ways and TPA should be obliged to issue such a notice to Insured members through SAIL and FORSE.
We feel extremely sorry to remind here that SAIL has not considered permitting renewal of the cases of members/ spouse of lapsed SAIL Mediclaim Policy who might have failed to renew in time due to certain limitations incl. the communications not reaching them in time. It is quite unfair for a Maharatna Company like SAIL to disown their Retirees in this manner. We see no reason for punishing them. We request you to kindly open the Scheme for such cases on a regular basis.
A study of the SAIL Mediclaim Guidebook and functioning of the SAIL Mediclaim Scheme, even from a distance, appears to be highly centralised in both formulation and implementation stages in which the Role of the SAIL Plants/ Units is minimal, limited to collection of Renewal Forms alongwith the necessary document. Because of this the Retirees are left as a helpless creature during their bad days health-wise as SAIL, Delhi is far away. We suggest that Plant/ Unit personnel in charge of Health and Mediclaim Scheme implementation must play an active role in the implementation of the Policy throughout the year and help the Retirees when help is needed.
We hope all the highlighted portions above will be a part of the Agreement and Guidebook this time and will be followed in letter and spirit by SAIL, The Insurance Co. and the TPA and last but not the least with the enhanced role of Plant/ Unit personnel.
--
Dr.V.N.Sharma, Chairman
Federation of Retired SAIL Employees
शनिवार, 21 मार्च 2015
FORSE Apex Council Meeting at Ranchi on April 12-13, 2015
FORSE Apex Council is going to meet
- on April 12-13, 2015
- at Ranchi
- starting at 10.30 AM of 12th April
- closing at 1.00 PM of 13th April
The Agenda will be circulated shortly. However members may send issues for inclusion in the Agenda.
Boarding & Lodging arrangements in Ranchi will be intimated after getting your Journey Plan.
Those who shall attend
- All Apex Council Members (A maxm of 3 members from each Member Association. More than 3 will be allowed with prior permission of the Chairman, FORSE)
- A maxm of 3 Invitees from thus far non-affiliated Associations.
- Individual SAIL Retirees interested in participating may also attend with prior permission of the Chairman, FORSE.
ü The attached Table has Train running details
for reaching and leaving Ranchi/ Hatia on the Meeting days. You are
requested to book your to and fro journey
tickets at the earliest and inform us of your arrival/ departure
plan.
ü In case confirmed tickets are not available the delegates may consider either Tatkal
tickets or via circuitous route
शनिवार, 14 मार्च 2015
Exchange of e-mails with SAIL, NIC and Emeditek & Resolution of standing Issues
Discussion with E-meditek officials
2015-03-13 12:13 GMT+05:30 Jim John <jim.john@emeditek.com>:
---------- Forwarded message ----------
From: Federation of Retired SAIL Employees <forsesail@gmail.com>
Date: 2015-03-12 18:45 GMT+05:30
Subject: Re: Medical Insurance
To: Jim John <jim.john@emeditek.com>
Cc: sunil sharma <sunil.sharma@emeditek.com>, "help.sail" <help.sail@emeditek.com>, ranchi.sail@emeditek.com, "cs.verma@sailex.com" <cs.verma@sailex.com>, secy.sail@sailex.com, Vaani Kapoor <vaani.kapoor@gmail.com>, .......
Dear Sri Aluria,
After recent exchange of chain of e-mails on various issues arising out of bad healthcare of our members under SAIL Mediclaim Policy Sri Jim John, I/c of SAIL Mediclaim operations in E-meditek discussed the issues and desired to know our expectations from the TPA and all concerned. Though my immediate response was "It is exactly as Your expectations from the Insurance Co , the TPA and the Hospital if your old aged parents get into health problem." Following this I summarized the various messages sent to SAIL, Insurance Co. and the TPA in last few years detailing the suggestions made therein to improve the health services esp belonging to the area where the TPA E-meditek has to initiate changes and make amends. A brief is presented below.
1. Fix up Hospitals of reasonable quality in nearby locations for both OPD & IPD. All IPD Hospitals must be permitted to entertain OPD cases, if possible.
2. All service activities of the TPA like a) Decision making b) Release of payment / reimbursement of OPD/ IPD Bills etc c) Issuance and reaching of Guidebook and ID cards etc. - must follow a time frame of a maximum of two weeks.
3. Permission for Cashless / IPD Treatment and Settlement of Bills for the same must not exceed Three hours from the time of receiving the message from the concerned Hospital to release the patient after Treatment.
4. Withdrawal of service of a Hospital for Cashless Treatment etc must be done after a month’s notice to the SAIL Mediclaim members.
5. For every difference of opinion or interpretation on the terms of service TPA / Insurance Co. should approach SAIL to circulate clarification/ clarified version.
6. the TPA and its staff must work more efficiently, if possible at least partly, with missionary zeal and give a personal touch to the dealings.
7. TPA must accept a member/ spouse as genuine if he/ she produces valid payment receipt.
8. I suggested to Sri Jim John to use e-mail ids forsesail@gmail.com andseearanchi@gmail.com for communication as and when required.
Sri John agreed to introduce the desired changes and suggested a meeting of his Ranchi office staff with me this afternoon for detailed face to face discussion and understanding. This was held in my residence and was attended by S/Sri Suchit Kumar and Dubey of Ranchi E-meditek office on behalf of their Head Office. The discussion was on similar lines as listed above.
Members may offer suggestions and hope for the best in coming days.
XXXXXXXXXXXXXXXXXXX
2015-03-13 12:13 GMT+05:30 Jim John <jim.john@emeditek.com>:
Dear Sir,We would like to inform you we have received Main Claim and the Pre-post Claim documents from the Insured and the documents were not misplaced from us. However, there was delay in processing because discrepancy was raised twice for the break-up of the final bill. Post receiving of the documents and after our internal review we have processed the claims.Claims details are as follows:1) 100091408558 (Main Claim)
Claim amount –Rs. 46573/-
Bill Amount- Rs. 48635/-
Settled amount – Rs. 36674/-
Deduction Details:- Non payable items - Rs. 2276/- (Hand care, Nebulization mask, face mask, thermometer, under pad, gloves non-sterile, cotton, mouth wash)
- Medical record charges – Rs. 100/-
- Refund amount - Rs. 6000/-
- Physiotherapy advice not available – Rs. 1200/-
- Not related with diagnosis – Rs. 750/- (HIV and HBsAG)- Pharmacy Return- Rs. 1635/-2) 100091408558A ( Pre-Post Claim)
Claim amount - 18960/-
Settled amount - 4819/-
Deduction Details:
- Not falling under pre post period - 10641/- (Pharmacy Bill Dated ,15/10/2014- Rs. 2857/-, 14/11/2014 - Rs. 129/-, 26/12/2014- Rs. 3910/-, 26/12/2014- Rs. 216/-, 26/12/2014- Rs. 2599/-, 13/01/2015- Rs. 930/- )
- Not falling under pre post period - 3500./- (Investigation Bill Dated, 20/11/2014 – Rs. 500/-, 14/01/2015 - Rs. 3000/-)We are asking our Ranchi branch to communicate the deduction details to the member so that if there is any clarification required by the member he can again approach us with the justification. Further, both the claims are under payment stage and will be disbursed to the registered bank account of the Insured within 3-4 working days.In case if you have any further query, please feel free to contact me.ThanksJim JohnE-Meditek (TPA) Services Limited577, Udyog Vihar|Phase – V|Gurgaon - 122016 | Haryana | INDIA
Tel: 0124-44666647 |Mob. 9560022541| Fax: 0124-4466677 |www.emeditek.com|From: Federation of Retired SAIL Employees [mailto:forsesail@gmail.com]
Sent: 13/03/2015 9:57 AM
To: ranchi.sail@emeditek.com
Cc: JIm.john@emeditek.com; N.Banchur@nic.co.in; help.sail
Subject: Ref: Suleman Ansari MIN Nos. 16700931 & 16700932Dear Sir,This has reference to an oral communication of Sri Suleman Ansari MIN Nos. 16700931 & 16700932. As per this he submitted in Oct and Dec 2014 two Bills of Indoor treatment at Apollo Hospital, Ranchi. The first Bill was of Rs. 50000/- and the second one of Rs.18000/-. The second one was misplaced in Ranchio office for a long time and retraced later. But even after more than couple of months have passed the Bills are not paid. Also about Rs.14000 seem to have been deducted from the first Bill and Rs. 16000/- fropm second Bill. Since his Customer login is blocked in emeditek.in/sailweb it is not possible to mention exact amount in Rs. and Paise. He visitedRanchi emeditek office many times but came back unsatisfied.Pl. let us know why the payments are not made even after a lapse of so many months and when the release of payments can be expected.thanks and regards--Federation of Retired SAIL Employees
XXXXXXXXXXXXXXXXXXX
From: Federation of Retired SAIL Employees <forsesail@gmail.com>
Date: 2015-03-12 18:45 GMT+05:30
Subject: Re: Medical Insurance
To: Jim John <jim.john@emeditek.com>
Cc: sunil sharma <sunil.sharma@emeditek.com>, "help.sail" <help.sail@emeditek.com>, ranchi.sail@emeditek.com, "cs.verma@sailex.com" <cs.verma@sailex.com>, secy.sail@sailex.com, Vaani Kapoor <vaani.kapoor@gmail.com>, .......
Dear Sri Jim John,
We already had known from Sri BNP Singh what you have communicated now. But still we thank you very much for your quick response and a positive attitude towards the Insured and his payment in this case seemingly after our intervention.We hope that such a positive attitude will be inculcated alongwith a good work culture and TPA staff-Insured relationship for every SAIL Retiree in future.
But as we have been communicating,it is just one of hundreds, may be thousand as it is difficult to keep track of oral communications or those made to different office bearers.It is not fair on your part to expect every Retiree to engage himself in unwanted dialogue with you or for us to stand guard on your functioning on their behalf.
We hope the system should function and speed of disposal and settlements will be the measure to make the Retirees satisfied. We hope you will work to that extentand let us know the actions taken to improve the system and output.
--
Dr V.N.Sharma, Chairman
Federation of Retired SAIL Employees
2015-03-12 18:11 GMT+05:30 Jim John <jim.john@emeditek.com>:
Dear Sir,At the onset we are admitting that we have received the Claim bill of Shri. B.N.P. Singh for Rs. 3231/- but due to incorrect bill entry in the application we have captured the amount of Rs. 2234/- and subsequently we have paid the same. When we have received Insured’s request for the payment of the remaining amount we have acknowledged it. Further, we have also reviewed and processed the claim for the additional amount and informed the Insured.Further, we are taking up the matter with our Ranchi branch for knowing the exact reason for routing the query to our head office.We deeply regret for the inconvenience caused.ThanksJim JohnE-Meditek (TPA) Services Limited577, Udyog Vihar|Phase – V|Gurgaon - 122016 | Haryana | INDIAFrom: Federation of Retired SAIL Employees [mailto:forsesail@gmail.com]
Sent: 12/03/2015 3:08 PM
To: vermag@emeditek.com
Cc: sunil sharma; JIm.john@emeditek.com; help.sail; ranchi.sail@emeditek.com; cs.verma@sailex.com; secy.sail@sailex.com; Vaani Kapoor;
Subject: Fwd: Medical InsuranceSri Gopal Verma,E-Meditek, Gurgaon,Dear Sri Verma,Following our previous messages on the non-helpful attitude and postures of your members of staff with added flavor of inefficient functioning indicating harrassment of our members I am forwarding the following message (emphasis ours) - the latest coming from a senior SAIL Retiree and a senior citizen of this country. We must bring it to your kind information that, not very long ago, one of our members, Late Asit Nandi from IISCo Burnpur was forced to commit suicide because of no payment of reimbursement released to him by e-meditek in time for his indoor treatment and Late Nandi's failure to return the borrowed money to his friends and relatives (A small part was released only after our intervention and his death). All through that period your people remained deaf and dumb then.Please let us know how many such messages of Mediclam members suffering at the hands of your staff will convince you that 'All is not Well with Meditek' and no attempt is being made ever by your organisation to help improve your service to primary, secondary or tertiary clients resulting in 'All is not well with SAIL Retirees too'. It would be better if you also take the business ethics alongwith the 'The ideals of the Govt as spelt out in the portals of the Govt for Senior Citizen' as given below in the box while responding:
---------- Forwarded message ----------From: Bnp Singh <bnp.singh1@gmail.com>
Date: 2015-03-12 9:58 GMT+05:30
Subject: Medical Insurance
To: forsesail@gmail.com
Dear Shri Sharmajee,Name BNP SINGHMY MIN NO 10700203.I would like to submit my own claim case for review.After treatment at SDM Hospital JAIPUR and ISPAT Hospital Ranchi, I Submitted a claim of Rs 3231/- ( RS three thousand two hundred seventy one ) on dated 24.11.2014.First payment Of Rs 2234/- only was made on dated 20.12.2014. How this calculation of money of Rs 2234 /- was reached is simply whimsical as no combination of bill claimed can add up to this money Rs 2234/- .Immediately on receipt of this money I lodged a complain at Ranchi office , who refused to entertain my claim for reduced payment. I had to ask for details of payment made but that also they went on dodging. Mr Dubey of Ranchi meditek office went on telling me that Ranchi office is not at all any place where I should look for any support in settling the claim, irrespective of what has happened any where. Meditek Ranchi office simply raised hand and refused to even talk on the matter.Matter was taken up with Gurgoan Office,who admitted their mistake in the month of January 2015. Finally Meditek Gurgaon mailed on 5th February that they will pay the balance money.After continuous and consistent chasing at Ranchi office ( where I had to visit many times) and Meditek Gurgaon office as also mail to Mr Sadhu / SAIL the money was finally paid to me on 04.03.2015.It was very tiring chase and unpleasant situation for the last two months. It is very surprising how this Organisation M/S Meditek has been chosen as service organisation , who in my case made deliberate mistake and almost refused to pay. At times I had come to understand in my mind that Meditek is bent on cheating me , hence my resolve that I will take this case to CASE TO CONSUMER COURT (.which I informed the as first notice ) my settlement was made.I am convinced in my mind with experience of my own suffering that Such people like Mr Dubey at Ranchi office / others are employed by Meditek only to HARASS Insured Sr Citizens.BNP SINGH
XXXXXXXXXXXXXXXXXXX
Thank you and your other colleagues on this chain of e-mails below who understood the plight of one of our members and took steps to resolve the long delayed payment of his OPD Bills. However, as I wrote in my prev message Sir, I would like to inform you that this is just not one case of one individual but this is happening day in and day out with dozens of SAIL Retirees Unduly delayed payment or settling of Bills, uncalled for delay in communicating approval for Cashless treatment to the SAIL Retirees, settling Bills for such cashless treatment before release of the patient and behavior of the majority of TPA staff during interaction with the SAIL Retiree is an agonising phenomenon for us. If they do not change their modus operandi, attitude towards and behavior with the SAIL Mediclaim members and their all round work culture, if FORSE is required to intervene on case to case basis it is simply not acceptable to us.
In view of this I request you on behalf of the SAIL Retirees fraternity to advise the e-meditek either to mend or to end. In latter case we would expect the Insurance Company to hire a more efficient TPA with good work culture for this purpose. I hope we are not asking for too much.
--
Dr V.N.Sharma, Chairman
Federation of Retired SAIL Employees
2015-03-11 17:13 GMT+05:30 <LK.Aluria@nic.co.in>:
Dear Sir/Madam,
Greetings From 'National Insurance'TPA E-Meditek has confirmed that they have released the amount of Rs.1970/- vide UTR No.AXISP15070037672.You rae requested to communicate the same to your member. We highly regret the inconvenience caused to member.warm regards,NICian Lalit K. AluriaSr.Divisional ManagerNational Insurance Co.Ltd.Divisional Office XII,3rd Floor 6/90 Padam Singh Road,Karol Bagh
New Delhi 110005Ph.011-28750189(D),FAX:011-28756258
IP No.351200-001,Mob No..9643003579
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Sri C.S.Verma,
Chairman,
SAIL, New Delhi.
Copy to : Shri K P Brahma, General Manager & Director, & Shri M Vasantha Krishna, General Manager & Director, National Insurance Co. Ltd.
Ref: Case of Sri Hiralal Ganguly MIN No. 8103642 (just below this message)
Dear Sir,
Please find one more of the many examples of inefficient and unsatisfactory mode of working of the TPA which I have been forwarding to you from time to time to draw your kind attention for necessary action at your end to advise the National Insurance Co. and the TPA to improve and correct their modus operandi in favour of the Members of SAIL Mediclaim Policy. I am sorry to say that the functioning of the TPA remained without a change in dealing with the SAIL Retirees, as you can imagine in the given situation of 60+, 70+ or 80+ years of age, they need more helpful and positive approach by all concerned including SAIL, National Insurance Company and the TPA, more so, in view of the inherent Rights of the individual SAIL Retiree and 'The ideals of the Govt as spelt out in the portals of the Govt for Senior Citizen' as given below in the box:
“Senior Citizens are a treasure to our society. They have worked hard all these years for the development of the nation as well as the community. They possess a vast experience in different walks of life. The youth of today can gain from the experience of the senior citizens in taking the nation to greater heights. At this age of their life, they need to be taken care of and made to feel special.”
“The National Council for Senior Citizens formed under the Ministry of Social Justice and Empowerment should take care of promotion of physical and financial security, health and independent and productive living and awareness generation and community mobilization”.
Many Ministers and senior leaders have also been expressing consistently such sentiments inside Parliament and out of it in favour of policy changes for ‘greater care’ of the Senior Citizens and the imperativeness to take care urgently of their various needs including financial and medical.
|
In spite of this not many positive actions are visible from any of the three -SAIL, National Insurance Company and the TPA- which could help ease long term as well as the day to day healthcare problems of the Retirees. As can be read in this case an OPD Bills for Rs. 1,970.00 on 11.11.2014 in TPA Calcutta office is yet to be paid. as it stands it is not clear how many times a Retiree should visit, call or try to meet for getting his/ her Bills cleared or, as I wrote to you earlier, for getting advice to the Hospitals for carrying out Cashless treatment without loss of time as Time is of essence for a sick person. Sir, I would like to inform you that this is just not one case of one individual but this is happening day in and day out with dozens of SAIL Retirees.
Also, much before SAIL announces the TPA's local Offices have also been informally communicating to our members that they are confirmed to continue as the TPA for the next term. If it is so, we request you to please evaluate their performance in consultation with us before assigning the job to them again.
--
Dr V.N.Sharma, Chairman
Federation of Retired SAIL Employees
*******************
Pl. let us know how and why a Retiree and the spouse is made to suffer due to the long time taking procedure of updating the site and the advantage to have such a Mediclaim coverage by more than a lakh of SAIL Retirees?
Our request and Appeal, sent to you in Sept/Oct 14, to complete the process of Mediclaim updating latest by 31st Dec every year does not appear to have been accepted and worked on. And we continue to suffer. Pl. let us know what alternatives are being worked on by SAIL.
$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Dated 31st Jan 2015
--
The Chairman
---------- Forwarded message ----------
From: swapan ghosh <ghoshsk2004@yahoo.co.in>
Date: 2015-03-09 15:55 GMT+05:30
Subject: Harassment by TPA
To: "kolkata.sail@emeditek.com" <kolkata.sail@emeditek.com>
Cc: "help.sail@emeditek.com" <help.sail@emeditek.com>, "vnsh44@gmail.com" <vnsh44@gmail.com>
Date: 2015-03-09 15:55 GMT+05:30
Subject: Harassment by TPA
To: "kolkata.sail@emeditek.com" <kolkata.sail@emeditek.com>
Cc: "help.sail@emeditek.com" <help.sail@emeditek.com>, "vnsh44@gmail.com" <vnsh44@gmail.com>
This is the message being sent by S. K. Ghosh, President , Association of Calcutta SAIL Superannuated Employees and Vice President of Federation of Sail Retired Employees.
This is sad commentary of functioning of TPA, Calcutta and how an old person is being harassed and humiliated. without any respite. The incumbent is Sri Hiralal Ganguly min 8103642 an ailing person.
He had submitted his OPD Bills for Rs. 1,970.00 on 11.11.2014 in TPA Calcutta office. Since he did not receive [payment after lapse of two months he had approached TPA office on 27.01.2015. As advised he submitted the xerox copy of pass book. He again visited TPA office threatened to check about the status of the payment when he was informed that earlier copy submitted by him was not legible. The receptionist took pains to get a xerox copy of pass book again afresh which was very legible.
He subsequently approached the Association for taking up with TPA to expedite the payment. I sent a SMS to Sri Partho Sarkar seeking his personal intervention on 09.02.2015. Sri Partho Sarkar replied to me on the same day which reads as under.
Qte :
Sir,
Insured has submitted the United Baank Cheque with Pass Book but Pass Book is not readable. Hence plz to resubmit the pass book with account no. & IFS code visible then I will try to move forward fopr the payment.
UNQTE
I immediately replied informing that legibele copy has already been submitted and requested him to ckeck up properly in the office. On this I got a reply on 10.,02.2015 from Sri Partho Sarkar reading as under
Qte :
Inquire in office and came to know the pass book is clear visual received and I fervently hope that the n payment will reach to proper bank account very soon without hassle. I apologise for inconvenience caused.
UNQTE
I accordingly informed our concerned member. Although he was sick he had gone to TPA office in last week of February 2015 to check up the position. Surprisingly he received very rough reply and was humiliated and asked to re submit all the papers and write to Gurgaon office if he so liked. When he approached TPA officer Ms Piyali Bose surprisingly she also misbehaved with him. Our member was socked and traumatised. As there is inadequate space for the visitors to sit Sri Ganguly came out and sat at the varanda outside and slowly he walked off the building. He narrated the whole story to us on 27.02.2015. He was advised not to go to TPA office again.
Narrating the above unfortunately episode I sent distress message to Sri Partho Sarkar on 04.03.2015 which is not responded as yet. Meanwhile Sri Ganguly also contacted Sri Partho Sarkar on 06.03.2015 and enquired aboiut the payment position as when he contacted Gurgaon office on 27th he was informed to expedite forwarding his papers again through TPA Kolkata. As he was very upset and also sick, he contacted Sri Sarkar on mobile. Sri Sarkar was very rough with him and asked him not to disturb on mobile and this is his personal mobile and very curtly told him to come to our office only for such enquiry..
This is one of many cases where members bills are inordinately delayed for payment and are being harassed . Sri Ganguly has taken bed and has been advised rest.
We need immediate intervention in the matter and settle the case as Sri Sarkar has himself confirm to me earlier that all the papers have been submitted in proper condition.
We also need the intervention of Shri V. N. Sharma Chairman forse and request him for taking up at higher level.
Regards
S. K. Ghosh
&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&
Dated 05th Feb 2015
Chairman
Chairman
SAIL, New Delhi
Dear Sir,
We expressed the problems faced by the SAIL retirees covered by SAIL Mediclaim Policy but not covered in reality after more than a month. Pl. look at the contents of the link http://sailex.blogspot.
- Almost all the Members or at least large majority paid their contribution and submitted to the appropriate offices of SAIL Plants/ Units in Jan 2015 for Mediclaim Insurance but they are not updated in the TPA's website http://emeditek.in/
sailweb/ yet. It is already over by a month out of three months and no updating, means not insured yet. It is not clear how long they should hang around with added worries on Mediclaim front. - SAIL Plant/Unit Offices responsible for issuing acknowledgement have not done anything yet. So, most of the members are not even aware whether they are Insured under SAIL Mediclaim Policy yet. Such a situation may also result in lapsing of the Policy for ever for no fault of the Member/Spouse
- It appears that automatic updating is not a part of the Mediclaim system. So a question arises as to what is this extension when Insured Retirees are not covered during the period of coverage starting 1st January 2015. The same mechanism of no coverage existed in previous years even when a regular Mediclaim Policy was implemented for Jan-Dec. every year.
- How do Insured Retirees or the spouse know whether they are covered for Cashless Treatment and get treatments if the need arise?
- The modus operandi / flow chart of SAIL Mediclaim appears to be [START] Announcing SAIL Mediclaim Renewal Policy ----> Submission of completed Forms by Members in Plants/ Units ----> Plants/ Units transferring the data to SAIL Corporate Office ----> SAIL Transferring the data to Insurance Co.----> Insurance Co.Transferring the data to TPA ---->TPA Uploads the data in its website ----> Insured Retirees informed through website---->Insured Retirees receive Identity Card and Mediclaim Guidebook by Post from TPA [END].
- With this long flow chart our experience had been extremely bad in previous years like the Identity Card and Guidebook not reaching to some even till July/ August.
Request to Reveal the Policy and modus operandi:
--
Dr.V.N.Sharma, Chairman
$$$$$$$$$$$$$$$$$$$$$$$$$$$$
Dated 31st Jan 2015
Sri C.S.Verma
Chairman, SAIL, New Delhi
Dear Sir,
Pl. find a write up from Dr. C.B. Chaudhary,one of our members, communicating the wrong listing of OPD & IPD Hospitals in the Guidebook & Website prepared and circulated by the TPA E-meditek the factual position corroborated by many others. We have been forwarding several of such messages in the past about the factually erroneous
http://sailex.blogspot.in/
In view of this we appeal to you to kindly take appropriate corrective measures to get the SAIL Retirees better care and treatment including in Healthcare matters
--
Dr V N Sharma,
Chairman
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Dated 30th Jan 2015
E-meditek
Gurgaon
Dear Sir,
Pl. read the letter in the following link, a copy of which was endorsed to you as well.
It appears that you have misunderstood the focus of the message and did not respond to the main issue.
As we understand the Mediclaim policy agreed to between SAIL- Insurer National Insurance Company Ltd)-TPA for 2014 has been extended upto 31st March 2015, of course on payment of members contribution. Our further understanding is that this has been provided to help members in taking care of their Health and treatment without a break. But validity of such extension is not in member's profile in their web login emeditek.in/sailweb nor in your responses till this day. We are aware of the cases who deposited the Form and the contribution within 24 hours of the announcement of extension but they are also not regularised.
It is not clear as to how do you or this extended scheme help members without break if submission of renewal forms and updating your site takes so much time. We will be happy to hear a positive response from you for all the members of the SAIL Mediclaim scheme.
DrVNSharma,
Chairman
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Dated 28th January
The Chairman
SAIL, New Delhi.
Dear Sir,
We would like to bring some important issues related to Healthcare and Mediclaim Policy and its inefficient execution by the TPA.
1. Though the current payment procedure through online or bank challan system is more efficient yet it is creating problem for large majority of the Retirees as they are either not conversant with the technique or the network is not working well in the rural or semi-urban areas. In view of this payment through Demand draft or Local cheque should be permitted.
2. Retirees face a serious problem in the SAIL's bigger Units as the Retirees, being in larger numbers, are required to stand in long queues for the whole day. The unlucky ones who fail to submit it on the 1st day may have to stand in queue on the next days. It is grave injustice to the Senior Citizens and overt and covert way of showing disrespect to the Retirees. Add to that shifting the Renewal form submission to April in scorching heat in which many of the Retirees may fall ill. Please deveop a fast, more comfortable and more efficient system for Renewal Form submission
3. I would like to draw your kind attention to a typical case of functioning of our SAIL offices, the TPA and the ever sleeping Insurance Company.
- In spite of our several communications the Mediclaim Renewal could not be acted upon by SAIL in advance to keep the whole policy and implementation effective in place by 31st Dec.
- Out of the many of the similar messages sent by our Members forwarded to you in the past, this time, One of our member Sri OPS Agrawal (MIN: 15401067) whose long note (extracts only) of distress because of the Mediclaim system failure is given below. He ran from pillar to post after depositing renewal fee on 3rd Jan, met an accident on 14th Jan and found the TPA's website non -functional, the Help SAIL office of the TPA taking it easy and not helping when the help was needed most, SAIL also not in helping mode and renewal letter being acknowledged 15 days after its receipt by the RMD Office. It certainly indicates that the Mediclaim Policy holding members are not covered during this intervening period of renewal because the TPA accepts the same through an update on their site after receiving the acknowledgement from the SAIL's concerned Unit office which takes months and months as per our information. This clearly shows the hollowness of the Policy and its operational part and also means that the SAIL Retirees are taken for a ride as far as the Healthcare matters are concerned.
I request you to kindly spare your valuable time to discuss the various issues facing us and find solution to them.
With regards,
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Dr.V.N.Sharma,
Chairman
Federation of Retired SAIL Employees
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