Oriental Insurance Company — Deduction in claim 60%

Address:

Thane, Maharashtra, 400615

Policy no. 131401/48/2017/7678 dt 22/03/2017
sir
i rajesh gangar sending this complaint on behalf of Mr. Ravji vadhan (patient kasturben vadhan ) ., there is a claim of cataract operation done on 01/02/2017 at Amber eye care micro surgery, naupada Thane west. which is also on your cashless panel hospital list.
Mr. vadhan has ask amber hosp. for cashless but the hosp deny and told him to go for reimbursement.
now total bill of one eye cataract surgery is 52500/- but MD india has settled for 24000/-, it shows that this is a package. if it is a package then amber hosp could have manage in 24000/-because it is in the cashless panel list., if amber hospital is not interested in doing cashless claim then why dont you remove it from cashless list, because one is in the understanding that the hospital is in the MD indias panel then there wont be problem of reduction of claim in settlement.
who is going to bare the extra money 28500/- which is paid, and also there is another eye cataract claim done on 08/02/2017 in same amber hosp of same amount, it is yet to settle.
now for both eyes if mr vadhan is paying 105000/- and settling 48000/- this is not fare to the customer who is paying 45000/ yearly premium.
please look into this matter and make justice.

Regards
For Ravji vadhan
Rajesh gangar