National Insurance Company — claim process partially

Address:

Health Insurance TPA of India Ltd. 5th Floor, Sterling Cinema Building, 65, Murzban Street, Fort, Mumbai- 400 001., Mumbai City, Maharashtra, 400001

Policy holder name - suryaben d shah and claim number[protected].

As per above mentioned claim number total billed amount of rs.88, 968/- and out of that only rs.41, 680/- approved by hitpa. (Health insurance of tpa india ltd) and balance amount shown under deduction and reason mentioned as as per reasonable customary.

If you can see in that major amount deducted under professional fees.

We have asked to provide your base how they have cross verify the same on 14th aug, 19

After that so many time we have send reminder for same and every time they reply same pls refer clause 3.12, reasonable and customary charges : reasonable and customary charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into account the nature of the illness/injury involved.

After that on 25th aug they send settlement letter and mentioned they refer nova hospital chembur

Also i have send the other hospital mine quotation and also i asked so many time the next step and also asked for grievance steps but they never reply on same.

Then on 5th sep jagdish bobade sr. Executive reply as patient has undergone surgery in non-network hospital, hence claim is approved as per policy terms under reasonable and customary charges clause. Claim approved in comparison to tariff rates in network hospital in vicinity area. Note : charges are checked with apex hospital-borivali also. - now he mentioned apex hospital but in settlement letter mentioned something else.

Also why we can go for their network hospital. We can go by where treatment going on. We have taken 2 years back surgery with same doctor and treatment going on continuously. Then why i can change doctor and hospital. It's obvious if doctor have more experience then he charged more.

After that also i have send so many reminder but no reply.

Then on 09th sep jagdish bobade sr. Executive reply and said now they ready to pay additional amount payable - 22188 but my total claim of rs.88, 968/- and previously approved rs.41, 68/- so what abt balance amount.

Now he send me email to approve the same. But i don't know the reason why i can approve the same. If same is reasonable then they have to send the same to our account. But after that as i not received the same so finally i reply on 12 th oct but as date still there is no revert from jagdish.

Also customer care also not support for same. Also in their website they have not update the same. Even when i call on mobile then still they not pickedup the call.

Custome care send the call on hold and then deduct without our permission.

Please help us to resolve this asap.

Thanks