Jain International Organisation [JIO] — Unnecessary Deduction made to amount claimed in Mediclaim Insurance

Address:	Mumbai City, Maharashtra, 400083
Website:	www.healthindiatpa.com

Dear sir,
Undersigned had applied with jain international organization for High networth insurance (Jio hni) mediclaim policy was issued in feb'16 in the name of Arjun V. Kothari through oriental insurance co, bearing no. 530000/48/2016/50, which. is Rs 15 lakh family floater plan for 1 year.

The patient has been diagnosed and later operated for fistula in ano at Gupta Nursing Home dated 9th Jan'17 (other details attached herewith)for which total amount claimed Rs. 45, 150 (details of expenses along with there receipts are attached herewith) for which Health India Tpa has been duly intimated for scheduled operation beforehand.

Duly submitting the claim form(3 copies) along with all the relevant req. doc. through registered post on dated 16th jan'17, against which, the Insurance Company paid Rs. 30, 000 only, citing reaosn as REASONABLE AND CUSTOMARY CHARGES PAID FOR OPERATION and deducted sum of Rs. 12900 as operation charges and completely ignored pharmacy charges of Rs. 2250 .
Amount as Originally Claimed :

1.Consultation charges - 400/-
2.ELISA (Retrovirus test charges) - 500/-
3.Operation charges - 42000/-
4.Pharmacy Bill - 2250/-

5.Total - 45150/-

The above policy does not states any ceiling charges or upper limit for the ailments against illness as stated in there terms and conditions of the mediclaim policy THUS explains high premium amount of Rs.44000 annually as they claim to cover all your hospital bills, thats the only reason we choose this policy on all of the other policies and now they say REASONABLE CHARGES will only be paid.
I mailed to there grievances team to explain the deductions they made in claim amount on Feb 8th, but no reply being received as such for the above.

I had claimed only the obvious charges of operation which i had duly paid to the hospital for the same and thus requesting you to order the Jio(oriental Insurance) for reimbursement of pending amount of Rs. 15150/- at the earliest.

All the other details are attached herewith.

Date : 15th feb, 17

Name of Insurer :
Arjun V. Kothari