[Resolved] Oriental Insurance Company — Partial payment of my claim amount

prghosh2

from Mumbai, Maharashtra

Address:

490024

I am prabir ghosh working in acc cement we have mediclaim of oriental insurance and tpa is mediassist. After admitted in bhilai sector hospital, they deducted tumor in cervical spine tumor and referred to vellore hospital for operation

My operation took place in vellore and now i have claimed as per mediclaim but they have deducted rs 20000 for non submit of reports where as vellore has given in writing that these required reports are in discharge summary, but still they are not clearing the matter

Secondly they have not paid rs 25000 against expenses in bhilai sector hospital telling that there is no line of treatment

I filed in irda and irda token no. [protected] dated 6.7.2016 still no result

Please take care of my non payment amount of rs 45000

Details are as follows

1. Mediassist no. [protected]
2. My ue no. 1001285 of acc employee no.
3 claim no.12551302
4 claim no. 12551323
5 policy no. 124600/48/2016/5870

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Aug 6, 2016

Complaint marked as Resolved

[email protected] ( Phone no. 07045456687) Dear Sir, The claim is got rejected under following clause. Claim No. Received On Policy Number Policy Holder Emp code Emp Name Relation MAID Beneficiary Clm Type Clm Amt App Amt Claim Status 12551302 16 Apr 2016 16:06 124600/48/2016/5870 ACC Limited 1001285 Prabir Ghosh Self 5007429921 Prabir Ghosh Reimbursement 23746 0 DRW Denial reason - On scrutiny of the all claim documents, the patient was admitted for Low back pain & had undergone oral medication & Investigation/Evaluation for the same. There was no active line of treatment As per the policy terms & conditions expenses incurred with no active treatment & diagnostic purposes are not covered, hence the claim stands repudiated as per the clause 2.3 Note & 4.10 Thanks, Sanjay Ghadi

Oriental Insurance Company customer support has been notified about the posted complaint.