Oriental Insurance Company — settlement of claim is not done properly and i feel harassment caused by tpa and oriental insurance company limited

Address:

400067

Patient name: mr. Kishor boradia
Claim no: hi-oic[protected]
Ic claim no: 131101/48/2019/000203
Policy no:- 131101/48/2017/19037

I had lodged a claim of my father (Mr. Kishor boradia) in reference to the above mentioned policy with health india insurance (Tpa) on 01st march 2018 of rs.1, 28, 890/- for strangulated umbical hernia. To my surprise they deducted rs.51000/- stating that (Reasonable & customary charges deducted)

First of all i had lodged a complaint with the tpa and insurance company regarding the deduction of claim. To my surprise they told me that they had deducted my claim to such an extent because they had compared the charges of other hospitals in metro cities for present ailment.

Let me put it in this way before operating my father for the above ailment i had taken quotations from 2 hospitals:-
1. Purohit hospital
This hospital is in borivali (West) mumbai – 400092 which is my locality.
They had given me a quotation of rs1, 80, 000/-

2. Vrindavan nursing home
This hospital where i was admitted initially gave me a quotation of rs.1, 80, 000/- and then after asking for a discount i decided to go for this hospital and my final bill was made of around rs.1, 28, 890/-

I am a middle class man with a sum insurance of rs.7, 00, 000/- under oriental happy family floater mediclaim – gold policy since last 6 years.

After comparing the charges of above mentioned hospitals i opted for vrindavan hospital as it is near my residence.

Please explain me how will i figure out that the charges are very high of the hospitals that they are charging us. I am unaware that what are the charges to which they are comparing the expenses charged to me by vrindavan nursing home.

Claim settlement like this are making us people loose faith in psu companies.
I always prefer to have a mediclaim in a psu company rather than private insurance company but such unreasonable settlement of claim worries us that are they just recruited to dishonour the claim.

Please look into the matter and provide me justice as i am fed up of the health india insurance (Tpa) and the oriental insurance company

Please look into the matter and reply me urgently.


Yours faithfully