Mdindia Healthcare Services — not satisfied with the claim settlement by tpa md india claim id 5722269 and 5785483

Address:

MDIndia Health Insurance TPA Pvt. Ltd. Mezzanine floor, Ballard House, Adi Marzban path, Ballard estate, Bearing CTS number 1185, Fort, Mumbai – 400001

I am raising this complaint to dispute the claim settlement done by md india tpa.
Claim no : 5722269 and 5785483
Patient name : dayaram waman pagare
Policy details: united india health insurance policy for retired employees of bank of india.

I raised a claim for amount of 471388/- but only 134150 amount is settled giving below reasons:

1. Rs. 183074 : usual & customary :as per maharashtra gr claim payable upto rs.134150 /-.

2. Rs. 85000 : visit & doctor charges already charged hence seprate charges not payable under reasonable and customary charges.
Query — this was a consultant visit charges which were mentioned seperately by hospital but still don't know why it is clubbed with iccu charges.

3. Rs. 30000 : o2 charges already part of iccu charges hence seprate charges not payable under reasonable and customary charges.

4. Rs. 30000 : monitoring charges already part of iccu charges hence seprate charges not payable under reasonable and customary charges.

Dispute on point no 3 and 4 is that this details were provided when requested for iccu breakup and is not seperately but part of the iccu charge. Still these charges are denied stating those are not payable

I am not sure if md india is stating that the patient should not consult any other doctor.

I have repeatedly requested to settle the claim correctly or redirect me to proper greiveance channel but till now have recieved no reply from md india related to greiveiance channel