Bima Lokpal — Incorrect insurance claim amount issued

Address:New Delhi, Delhi, 110047

This is with regards to the claim approved for my husband HE has undergone a mini PCNL surgery for stone removal on 17th April 2017. Post-surgery due to UTI he had fever spikes upto 103 degrees and could not be discharged. Post this he underwent the stunt removal surgery. All this was approved by the TPA(Vidal). A running bill was also shared with them. On the day of the discharged TPA shared final claim for INR 76000/- only and I had to pay rest 71, 000/-. As communicated by Anil I am eligible for an o[censored]p to 3, 00, 000 which includes the medicines, etc. We received approval from TPA for INR 40000/-, then INR 1, 00, 000/- and full and final for INR 76000/-. I was never in the whole course informed about any deduction. I am not sure on what ground the approval has been made but there was no information shared with me before or till the day of discharge. I have been charged unnecessarily, miscommunicated and mislead about the claims. There was no transparency and I have been cheated.
Was this information helpful?
No (0)
Yes (0)
Complaint comments 

Comments

Mansit, Even if you have coverage of Rs 3, 00000/- there may be sub limits for certain treatments depending on policy bought, however you may insist the insurer to furnish item wise details of dis-allowance/approved etc in writing & also you may refer terms & conditions of policy document & you may insist insurer to pay balance amount if approved amount is not as per policy terms & conditions. In case no satisfactory reply is received from
insurer, you may approach insurance ombudsman for your grievance.
I can help you on such problems... for any claims related issue pls call me...

[protected]

Post your Comment

    I want to submit Complaint Positive Review Neutral Comment
    code
    By clicking Submit you agree to our Terms of Use
    Submit

    Contact Information

    Delhi
    Delhi
    India
    File a Complaint