[Resolved] The New India Assurance Company Ltd & Md India — mediclaim claim
Kkamlesh d panchal
I have claimed in MD INDIA for my medical expenses but I received very few amount cheque which is not acceptable by me. The recent letter which I wrote to MD India is below you will understand the whole matter.
Kindly go through the letter.
Madanlal M. Jain
Mumbai – 400 080
Ref : Policy No.140600/34/09/11/00009907
CCN No.MDI0686796; MDI ID No. : MDI5-[protected]
Sub : Non Acceptance of claim cheque.
With reference to above please note that I hereby returned you the claim cheque amounted Rs.1,14,638/- dated 28/06/2010 cheque No.001582 . Also I request you to go through following points:-
1. I have mediclaim since more than 15years.
2. This is my first claim.
3. My Sum Insured is Rs.1,50,000/-
Cumulative Bonus is Rs.75, 000/- 50% (check with NIA)
Total Rs.2, 25,000/-
4. Also note that I have sent all the policy copy to you with this claim.
5. Total Sum Insured Rs.2,25,000/-
Hiranandani Hospital Cashless Rs.13, 685/-
Now eligible amount is RS. 2, 11,315/-
6. As per NIA mediclaim policy I am eligible for the package and all relevant medical expenses on the criteria of 1% of Sum assured. My 1% of Sum Insured is Rs.1500/-(Please check my policy is for Rs.1,50,000/-)
7. You had calculated all the expenses @ Rs.1000/- which means you have given 50% less amount than my eligible amount.
8. Now I request you to go through all the bills once again.
9. Total balance Sum Insured amount is Rs.2,11,315/-
10. I have received your cheque for Rs.1,14,638/- (which I hereby returned you back)
Total Bill Submitted
Claim Amt Eligible Amt
• Cardio Vascular surgery Rs.2,49,000/- Rs.1,45,200/-
• Bed Charges RS.3900/- Rs.1,500/-
• Lab Medicine Rs.13,565/- Rs.5,426/-
• Material Management Dept Rs.74,379=70/- Rs.29,751/-
• Miscellaneous in Hospital Bill RS.1,523/-____ Rs.1,523/-
TOTAL Hospital Bill Rs.3, 42,367=70/- Rs.1, 83,400/-
• Pre Hospitalisation Doctor Charges Rs.2050/- Rs.2050/-
• Pre Hospitalisation Doctor Charges Rs.250/- Rs.250/-
• Pre Hospitalisation Investigation Rs.15,500/- Rs.15,500/-
• Post Hospitalisation Rs.740/- Rs.740/-
• Post Hospitalisation Medicine Rs.1258/- Rs.1258/-
• Post Hospitalisation Medicine Rs.1771=25/- Rs.1771=25/-
• Post Hospitalisation Medicine Rs.133=40/-____ Rs.133=40/-____
TOTAL Claim Amount RS.3, 64,070=35/- Rs.2, 05,102=65/-
Now once again I request you to go through all the papers and please send fresh cheque with my eligible amount.
Encl: As above
1. If Rs.1700/- per day bypass package cost is Rs.1,65,000/-
2. Our Eligible amount Rs.1500/- per day allowed is Rs.1,45,200/-
(Hospital Tariff attached herewith.)
Complaint marked as Resolved Aug 13, 2020
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