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[Resolved]  Oriental Insurance / Raksha Tpa — mediclaim disallowance

I have family mediclaim policy from Oriental insurance since many years. My policy no is 111700/34/08/11/00002925 . and my personal insurance limit is Rs 400000/- I had to undergo
surgery of Right Ureteric Calculus. Total Claim amount was Rs. 39669/ whereas i was paid Rs 29669/-
Rs. 10000/- was deducted from surgeon charges saying it was not proportion to room rent.
It is shocking to hear this. Even though my insurance limit was much higher I opted for economy
class in the interest of my insurance company. If I had opted for higher class I would have been paid the
full amount. Before surgery, I enquired at Bombay Hospital where I was given the estimate of Rs. 100000/- approx for same surgery. Do insurance company and their Tpa want their policy holder to incur more and more towards their illness to get their claim fully. Can any one explain this logic.

My claim no is[protected]. and my cell no is [protected].

sampat parmar
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Aug 14, 2020
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    Raksha Health Insurance TPA
    Customer Care Service
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    Raksha Health Insurance TPA Phone
    +91 12 9428 9999 [Faridabad]
    +91 22 6787 6666 [Mumbai]
    +91 80 4283 9999 [Bangalore]
    Raksha Health Insurance TPA Address
    India
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