Mdindia Healthcare Services — TPA rejected claim after giving pre-authorisation before hospitalisation

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Gurgaon, Haryana

Hello, My father has a policy from New India Assurance, wherein MD India is a TPA. I applied for pre-authorisation and got approval for engiography, costing about 15, 000. In engiography my father had blockage and doctor recommended for two stents (Step 2 - Adding two Stents). Doctor went ahead and did the procedure. TPA asked for all the previous policy documents (previous 4 years with STAR Health) and only after back and fro 3 times, it gave approval for initial process (Engiography - Step 1) I applied for enhancement (step 2) of already approved process, and enhancement was for INR 3, 79, 000. TPA again asked for previous policy documents (already submitted at step 1) and later declined the new enhancement and also the earlier approved pre-authorisation. I was really surprised that how can a TPA decline pre authorised amount (15, 000) and also declined the enhancement (INR 3, 79, 000). As a result with very great difficulty i had to pay INR 3, 79, 000 from my own pocket, i did not had the money and with no option left i had to borrow money to release my father from hospital post medical procedure. I want help if someone can help in getting the reimbursement from TPA else help with filing complaint with IRDA. Regards, Tushar [protected]