National Insurance Company — Rejection of my medical claim

Address:

Bangalore, Karnataka

Sub: rejection of my medical claim – request redressal of my grievances – group med claim policy number: 602000/50/16/10000373.

I have admitted my wife on …08.02.17 in the hospital abhijay for treatment for multiple myoma. My wife was operated on …08/02/17………… for removal of multiple myoma. She got discharged on 10/02/17………. Please find attached all her relevant medical records which are available with me for your scrutiny. Towards this surgery i have spent an amount of rs…91, 053 (Ninety one thousand one thousand and fifty three only)…i have submitted all my documents in original for claim from the national insurance company ltd through their tpa m/s. Paramount healthcare management pvt ltd, greams road, chennai. The tpa has rejected my claim under clause first time mentioned 4.10, second time mensioned 4.6 – repudiation reason. I wish to bring to your kind notice that my wife’s myoma removal surgery is not for diagnostic or evaluation purpose and it is purely a treatment. My claim is also purely for the said treatment. Hence from my view it is a full treatment and i am eligible for the said genuine claim. I hail from a middle-class family and i rely on the insurance claim if i have to foot such a fat medical bill. Rejecting my claim under some clause puts me into a lot of financial hardships and mental agony.
May i request you to evaluate my claim at your office and give your esteemed order so that my expenses are reimbursed by the national insurance company ltd at the earliest.