Share Some Thoughts................DK/59....EDITOR 'S NOTE:..(PENSIONERS WITH VISION PROBLEMS NEED READ ONLY THE CRUX WHICH ARE IN RED LETTERS..)

FEDERATION OF RETIRED LIC CLASS I OFFICERS' ASSOCIATIONS 

President :    N.P. Bali 705, Sur, Veena Saaz, Thakur Complex, Kandivali (East), Mumbai - 400 101 Mob : 9820324213 Email Id - npbali@hotmail.com

General Secretary :    D Krishnan No.6/1, Sreshta Riverside Apartments, Wood Creek Road, Nandambakkam, Chennai - 600089 Tel : 9176635967 / 044 42850049. Email Id - dkrishnan1@gmail.com

E circular No.DK/59                                                   26-03-2019

Dear Friends,

Sharing some thoughts/facts ....

Here then goes the next salvo ...  Not that there is any significant development from the time the last one, DK -- 58, went out;  yes, today is the 26th of March , and we had some indications that our case in SC  may come up for Hearing. Contrary to that expectation was the way certain facts around the Court suggested, that it was quite unlikely because the new Bench to Hear our case had not been constituted, and the Date was only a computer generated one. Now we understand that the Case never came up in the main list for the day, and that there has been no movement on this front. So we will need to wait and watch for any further news from the SC.

Meanwhile I attended the the 4th Biennial  General Body Meeting of the Odisha Association, which indeed is a composite Unit, representing the jurisdiction of the 4 LIC Divisions in Odisha, viz,Cuttack, Sambalpur, Bhubaneswar and Berhampur. It was held on the 24th of march, Sunday, at the STC premises of Cuttack Division. The Day-long meeting was well organized and over 70 members from different stations in the state attended the meet. Sri G N Panda the general Secretary of the Association, came up with a very comprehensive Report of Activities  running to about 8 pages of printed matter. They had invited one of the popular Literary persons of Odiya literature, and he delivered a very meaningful talk, as to how even as elders, we needed to consciously cultivate basic values of life, so that our happiness quotient is kept high.

Members  raised doubts over our continually postponed Dates for the Hearing of our Case in the SC, and wondered whether many of us in later ages, would live to see the fruits of these efforts. 

I mentioned to them about  the positive winds that are now seen to be blowing in the form of RBI getting their Pension Revision, and there is also expectations that IBA will come up with certain reliefs on these lines and that the interval of time for the Court Case to resume, could see some benefits flowing to us too, in the interregnum. I did indicate that

i.                   The Family Pension matter is already being put up to the LIC Board for a change of the percentage from 15 to 30.    &

ii.                 There is also an indication that the super seniors (upwards of 80) may also be given the benefit of percentage increases in pension on the lines of the Central Govt Retirees.

So, I said, instead of getting stressed over the delayed court dates, which are not exactly in our control,  we could as well hope to see slow movements  on small benefits coming to us, on their own. We are also positive on the results ever since we made certain direct efforts through PMO, on various issues including the above two. 

Elections were also conducted, and a new Committee took over. Their Founder-President Sri P Swain , who passed away suddenly in Nov last year, had to be also substituted by a newer person, and the choice fell on Sri N C Bhatta, to take over as President. Sri G N Panda was re-elected as  Secretary.

I had visited  Ernakulam  on the 17th of march for some personal matters. The Local Association  took the opportunity to convene an EC meeting  on that day. They were quite categorical that some intervention from our side should be there on the way the Mediclaim  scheme was being administered. They also sent me a gist of some of the cases where they had noticed difficulties, in obtaining the benefit of Health Insurance Cover as intended/provided for in the Scheme .  I felt something needed to be done expeditiously, as the elderly were being put to a lot of hassles. I have therefore addressed a communication to the ZM Southern Zone , which I thought I could reproduce here for your knowledge.

 So until next time , with Greetings to all

D.Krishnan

The Zonal Manager,                                                                                                                                                                                                                                                                25-03-2019

LIC of India,  Southern Zonal Office,

Anna Saalai, CHENNAI – 600002.

Dear Sir,

I am writing this in the context of a lot of difficulty being experienced by the Retired Officers of LIC , in the use of  Mediclaim Benefit, administered  by New India Insurance Co. and the TPA , which is Vidal, in the case of the  the state of Kerala.

I am enclosing copy of a grievance letter received by me , as the General Secretary of the Retired LIC Class I  officers' Federation. In fact , on my recent visit to Ernakulam, in a Meeting I attended,  of the local Association, a whole lot of these were made out, and they pleaded that I take it up with the higher Office of LIC, to be in turn taken up by them with the New India and the TPA -- Messrs Vidal, before the contract is renewed for the next Financial Year.

As you will see from a few cases narrated here, the spirit of  extending the insurance scheme to the retired officers is missing. The cash-less scheme was described by some in the meeting as Less-Cash scheme.  While there are rules to allow claims, there seems to be a sense of apathy in disallowing without proper accountability.

For a person who claimed well within the limits allowed to her, a major amount of over 38000/- was disallowed and the officer concerned did not know why this cut was made. On enquiry the explanation was that the Room Charges claimed were beyond limit and all other expenses to the extent of  the additional limit on Room , was disallowed.  Actually Room charges were 4500/- only and the Nursing charges were clubbed with Room charges  to make it beyond the allowed limit of 5000/-. This was very unfair, and even if for a moment, the clubbing is accepted, the percentage of excess is hardly  1 or2 % and the cut in the claim amount is to the extent of 9 or 10%!

            Clubbing the Nursing charges with Room Rent, twists the whole scheme,  in an arbitrary manner. Where ,even when , actually Room rent is exceeded , the whole of expenses of Treatment cannot be cut down to the extent of the excess on one item like Room rent. These violate the very spirit of the insurance protection sought to be offered by the Cover.

The instance quoted, where the New India Office had gone ahead and disallowed 19000/- on Cataract Surgery, when in fact the claim was well within the limit of 60,000/-, it was observed that the administering office of New India  did not have the copy of Policy conditions, and yet they had gone about disallowing a big amount!

This insurance on Health and Treatment is a facility allowed to us in old age. One does not have the energy to  look deep into how things were calculated by the office of New India, particularly when they disallow a big part of the Claim.  The New India Office has to explain up-front as they make the payment, as to what was disallowed  and why. Every case where an amount is disallowed has to be clearly explained. Otherwise it appears that out of' Grace' something is given  and one has to accept it without demur.

The matter relating to how the Cash-less scheme works has to be re-examined from the practical perspective of the person hospitalised, and made more humane than it is now.  There are cases quoted in the grievance list here, where the discharge of the patient from the Hospital,  had to wait for hours for the  authorisation from the TPA to come in.  Even where at every stage , the pre-authorisation requests were made in time, the approvals received fell well short of the amount needed. The very purpose behind the Cash-less facility is defeated by this very inconsiderate approach.

Our request here is to have these matters thrashed out with the Insurer before renewing the contract this year for the on-coming year 2019-20.

A few things must be made mandatory as part of the understanding on the Contract with the Insurer:

1.  Any Amount disallowed , when clearly  within the Limit allowable, must be Explained up-front.

2. The TPA must be made responsible  for playing its intermediary role in a humane and responsible manner--- accountable for delays which makes the party concerned, make the payment  to Hospital, for discharge in time, in a Cash-less scheme.

3.All Offices of New India administering the Insurance scheme for us, should be made aware of the Conditions of Policy and the Limits.

I do hope this will be taken up with all the seriousness it deserves, in the interest of the aged Pensioners of LIC. In fact, I would be grateful for a feed back on what is being done on this paper.

Thanking You

D.Krishnan, General Secretary                                Encl: The Grievance letter from Ernakulam centre. ====================================================================== Janardhanan  Nair  P                                                                                  18-03-2019 President, Retd. LIC ClassI Officers Assn, Ernakulam

Dear Sir,
As desired by you yesterday, I am mentioning a few of the problems:
1.  Case of A.Aiyappan Pillai - Of course it is an old one. Still I am giving it as an example of how the purpose of 'Cashless' is defeated. Pre-authorisation requests were sent in time. The amount sanctioned each time was very low. I followed it up personally. They assured me that at the time of discharge full amount will be settled. But unfortunately, the bill was 5 lakhs+ they sanctioned less than half of it. He had to remit Rs.2.6 lakhs to leave the hospital. On subsequent claim major portion of it was sanctioned. That is not cashless.

2.  P.P.Jose, our E.C.member - He had surgery for removal of prostate 2 weeks back. Bill was around 2 lakhs. No sanction till 8 pm. Then he remitted the entire amount to go home. Next day the Hospital informed him that Rs. 1.21 lakhs has been sanctioned and he got refunded by them. Now he has to submit a claim and wait for 2 or 3 months to get the balance.

3.  Gracy Panicker - She underwent angiogram/angioplasty at a hospital in Trivandrum City. She was in Hospital for 4 days including 2 days in ICU. Rs. 38,356/=was disallowed. She submitted an appeal. The reply shows most of the items reduced to 91.32% on the ground that she has occupied a room above eligibility. Her option of sum insured is Rs. 50 lakhs. The room rent was only Rs. 4500/=. Ceiling of room rent is Rs. 5000/= for TVM city. Sasikumar and myself went to Vidal Office and discussed many issues. Mr. Midhun agreed to examine and he wanted me to give a request to review this case. Finally Rs. 3994/= was paid. Still Rs. 34,362/= remains. There is no explanation. 4.  Latha Sudhakaran - Her husband, a sufferer of Parkinson's disease, had a cataract surgery. Policy shows Rs. 60,000/= as ceiling for each eye. Her bill was Rs. 55,000/=. They disallowed Rs. 19,000+. On my advice she represented to New India. An officer of New India asked Latha to produce the policy. She requested the officer to contact me. The officer was telling me, they don't have a copy of the policy with them. While agreeing to submit a copy of their policy to them personally I mentioned my age. The officer, a lady, felt compassionate, complemented me for studying all these things and doing such follow ups at this age and agreed to review without copy of policy. A further payment of Rs. 9.000+ was given. Latha accepts this because she is not in a position to take the trouble of gong to Ombudsman.        I can mention several examples. But what I want you to convince them is that the claim we make is  our right and  they are not paying at their grace. As such every claimant must get an intimation giving details of all items disallowed. Thanking you, Yours sincerely,                                                                                                                                                              P.Janardhanan Nair.