National Insurance Company — Unauthorised deduction and Unethical behavior

Address:

ANUPAMA HOUSING COMPLEX, PHASE-II, FLAT-74CC/03, VIP ROAD, KOLKATA-700052

My wife is a cancer patient. She had undergone a major surgery on 25.03.2021. It was a cashless claim from Medi Assist TPA under a corporate policy taken by my son Shri Suvajit Mukherjee.

According to the corporate policy, the employee has to pay 20% of the Bill amount as CO-PAY. Accordingly they did not pay Rs.91, 580.00 and Rs.14, 430 as non-medical expenses. Rest they have pad directly to the Hospital: Tata Medical Center.

Subsequently, we lodged the claim with National Insurance against my policy with the National Insurance.

The third party assurer of National Insurance "Heritage Health TPA" has re-opened the entire Bill amount and disallowed some expenditures which has already been approved by Medi Assist TPA.

We firmly believe that there is a policy guidelines about the eligibility/ Non-eligibility issued by IRDAI which are being followed for all Insurance Companies.

How then the TPA of National Insurance can disallow the expenditures allowed/approved by Medi Assist and under what clause? We did not claim the entire amount of the Bill, we claimed for the co-pay amount.
My POLICY NO:[protected]
CLAIM NO:HH[protected]

I shall look forward to getting your pro-active response at the earliest