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[Resolved]  New India Assurance — cheats for claim reference: ccn# 19824562 under policy#[protected]_empbase

Hi,

I have corporate medical policy under my wife is also covered.

So for wife's maternity expenses reimbursement, i submitted the all required documents including medical prescription and everything.
Below is the breakup.

1. Hospitalization bill for baby delivery: 45, 730/-
2. Medical bill during hospitalization: 4, 025/-
3. Pre and post medical bills: 25360.68
Total: 75, 115.68/-

As per our corporate policy 75, 000/- is limit for all maternity expenses.
But today i received mail of approval of rs. 19, 411/- and i completely disagree with this approval.

After checking approval document i saw 69, 614/- rupees is payable amount after calculation, but below that they deduct 50, 203/- rupees from it stating "(Less) policy excess / deductible".

So i contact my tpo regarding this, so he told me something about ppn rate and because of this deduction happen,

Now the thing is i didn't do inquiry about cashless where all this information pass to patient/relative instead i choose to go for reimbursement due to some emergency situation for which i have already provided document.

So after discharge and paying all my bill i applied for reimbursement and after some days policy team is asked me for some ppn document which i was not aware of such document, so i rush to hospital and got that document,
On which it was mentioned that i didn't contacted for cashless facility and i choose eligible room category under policy. But it was not mentioned how much is ppn rate and how much i need to pay by myself, no one told me about it before and after admission.

While taking admission hospital staff told me expenses can go upto 65k to 75k. And also tpo already told me before this that my limit is 75, 000/- so without thinking too much in emergency situation i paid by my pocket only.

So now i'm in lot of trouble because of this cheats.

So i feel like cheated by insurance company.

As of now i have submitted 72 documents including ppn declaration form with clarification letter stating reason for not availing cashless facility.

So i request new india assurance company to clear all my reimbursement bill.

Details:
Tpo: mediassit india.
Insurance company: new india assurance.
Claim refrence number: 19824562
Policy number:[protected]_empbase
Medi assit id: [protected]
Date of submitting documents: 12th june 2019
Date of submitting additional required documents: 17th june 2019
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Aug 6, 2019
Complaint marked as Resolved 
after regular followup insurance company reimbursed 36k
Jun 26, 2019

Complaint Status

New India Assurance customer support has been notified about the posted complaint.
Jul 04, 2019
Updated by Nilesh Lande
No updates yet,
I need to pay my credit card bill which i used for hospital expenses by trusting them,
I feel like dying because of such financial tress. I shouldn't have been trusted on policy.

Still waiting for settlement...
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