Oriental Insurance Company — delay in claim reimbursement and not giving details of amount disallowed

 
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Thane, Maharashtra, India
 suresh9911 on Nov 18, 2018
Health insurance policy no. 13500/48/2018/4224
I had submitted reimbursement claim for rs. 182986/- at kalyan oriental insurance company limited on 23/07/2018. My claim is finalised only after constant follow up with oriental insurance company at kalyan and payment is received for rs 153394/- on 10/10/18. It is indicated on the discharge voucher cum claim settlement letter that rs. 12548/- is disallowed.
I would like to state here that:
A. There has been an abnormal delay for more than two & half months in disposing off the case by insurer.
B. This delay gives a message to go for cashless rather than reimbursement if an insured requires timely benefit from insurer.
C. Surgery would had been carried out at fortis hospital by availing cashless service, however, as estimate for the same was found to be high surgery is carried out at other hospital.
D. I had requested to details of amount for rs. 12548/- disallowed from my claim. I need to know which items are disallowed from the bills. But till today i have not received either from sr. Executive: relationship management, health insurance tpa of india ltd or oicl, kalyan
Sir, in fact, i had discontinued renewing health insurance policy with new india assurance company being better terms and condition and claim settlement procedure with oicl as i have been told by the agent.
It is therefore requested to clarify above points and details of amount disallowed for rs. 12548/- from my reimbursement claim may please be made available treating this as my grievance.

Complaint Status


[Nov 18, 2018] Oriental Insurance Company customer support has been notified about the posted complaint.
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    Oriental Insurance Company - delay in claim reimbursement and not giving details of amount disallowed