Mdindia Healthcare Services — CCN : MDI5742599 policy number: 215502/48/2019/2345

Address:

Head Office: S.NO.46/1,E-Space, A2 Building, 3rd Floor, Pune Nagar Rd., Vadgaonsheri, Pune - 411014 (India) Cashless Tollfree No : 1800-233-4505 Mob.: 09326442922 Cashless Fax No :020-25300030 Cashless UAN Number (Voice) 18602334448 Cashless UAN Number (F

Mrs. Mamta Rani was admitted to Maharaja Agrasen Hospital, Road No 35 Rohtak Road, Punjabi Bagh, Near Shivaji Park
Metro Station, Punjabi Bagh, New Delhi on 22.07.2020 in emergency due to STROKE which caused paralysis to the upper body. The policy in force was from "The Oriental Insurance Company Limited" which was continuing since 05.12.2009 and renewed thereafter every year, latest sum insured Rs.2, 00, 000 from TPA M/s MD India Health Insurance TPA Private limited under Happy Family Floater 2015 silver plan. As per the cashless authorization letter shared by TPA vide claim number MDI5742599 dtd. 27.07.2020, the TPA has approved only INR 25951/- against hospital approval submitted for INR 119676/- wherein ICU charges claimed by Hospital is 6000/- per day and visiting charges 1500/- per day. TPA has made deductions of INR 93725/- wherein ICU/NURSING CHARGES have been restricted to INR 15000/- against inflated amount shown as INR 47500/- for 6 days whereas as per policy the entitlement is 2% of sum insured per day which comes to 24000 and made complete deduction of visting charges and Investigations on proportionate basis i.e. deduction of 68.4% in relation to ICU charges approved. Further TPA has reduced the claim by showing discount of INR 16389/- which was never claimed by Hospital. Despite repeated emails dtd.27.07.2020 we are not getting any response from TPA on said deductions and why the claim is not passed as per limits in policy despite sum insured in INR 2, 00, 000.

I have also lodged a complaint with MDA TPA site, complain number 131496 but there is no response.

This is purely manipulation of claim and unjustified deductions on part of TPA.