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[Resolved]  New India Assurance Mediclaim Policy - Tpa Medicare — CASHLESS CLAIM SANCTION MENTAL HARASSMENT

I have corporate Mediclaim Policy under MEDICARE TPA Srevices. Policy No. 510700/34/09/87/00000161 and Mem No. 02I00571595A named KALLOL CHATTERJEE. I was admitted in Apollo Gelnogles with accute neck pain with left brachalgia on 26.10.2009. After investigation and based on MRI report doctor operated on 29.10.2009. The surgery performed on C5/6 microdiscetomy with fusion with plating (Globus Plate) under general anasthesia. My preliminary claim comes on 29.10.2009 and I was supposed to discharge on 01.11.2009 and the final bill and despatch summary was sent by fax to them at around 10:30am. The total bill was Rs. 1,28,945.04. At first they sanctioned total Rs. 80000 andwhen I called kanchan Aich of Medicare TPA he answered that doctor fees is so high. After long discussion they sanctioned total 90000 saying that now they can't differenciate between medical and non medical items so they can't give more. In this way they keep on mental pressure on me in this issue. After that he transfered the line to Mr. Deepnarayan Mukherjee and he also quostioned about doctor's fee and also for not having enough manpower to check the bill. After long long discussion first they enhanced to 1,05,000 and at last 1,22,000. There attitude is that we are begging infront of them and what they will approve we have to accept that and they do mental harassment to patient. My policy sum assured is Rs. 200.000 but still I am not able to get the cash less facility in corporate insurence. I personally feel that this type of activities from Medical Insurance should be stopped.

CASHLESS CLAIM SANCTION MENTAL HARASSMENT
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Complaint marked as Resolved Aug 14, 2020
Complaint comments  2 CommentsShareTweet

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Medicare TPA is just making money out of the insurer. Whenever any legimate payments is to be made to the insurer, they just casually sanction petty amount and reject all claims as inadmissible. Something should be done against Medicare TPA Services
Mrs Mahua Mukherjee underwent some critical and emergency operation at Delhi on 01 Nov 2014.She was admitted in Divya Prastha Hospital at Palam, New Delhi for 04 days.Total amount was paid by cash as the hospital was not listed under New India assurance.It was intimated to the concerned of New India assurance on the same day.The total amount paid was 72000.To our utter surprise we could find out that the reimbursement amount credited to account is only 18000.The concerned staff at Kolkatta Mr Arijit Das could not explain exactly why it is so. My question is : If cover is of 1 Lac, requisite info and documents produced, who authorise them to decide how much to be paid ? Member No is [protected]B and Policy No is 512200/34/14/01/00000622.Can anybody Pls suggest what is the way out now because the amount is pretty much for the family?

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