Oriental Insurance Company — unexpected behaviour and mental agony regarding vipul medcorp insurance, tpa limited indore

Address:

Indore, Madhya Pradesh, 452001

Dear Sir / Madam,

I would like to inform you that I am having a Oriental Insurance Mediclaim Health Insurance policy - (Vipul MedCorp Insurance TPA Private Limited) for the last more than 7/8 years and for the first time I had to visit hospital for my son's knee surgery (ACL Reconstruction).

The mediclaim department of Medicare Hospital, Indore sought an approval as per my mediclaim facility and Vipul MedCorp Insurance TPA Private Limited sanctioned approval mentioning that I am eligilble for a private room. Accordingly, the package was given by the hospital as approved by Vipul MedCorp Insurance TPA Private Limited. Unfortunately, at the time of discharge, when final bill was submitted for approval, to my surprise, Vipul MedCorp Insurance TPA Private Limited raised a query and said that I was eligible for a semi-private room package and not for a private room package. When contacted their executives and informed them about their sanction letter wherein it was clearly mentioned 'Private Room', they told that it was mentioned by mistake and they would approve amount as per semi-private room only. I told them that if they had informed me in the beginning at the time of booking room / package in the hospital, I would have booked semi-private room only. On this they could not give any satisfactory reply. Finally, I had to end up paying a hefty amount being the difference of both the packages for no fault of mine. Moreover, Vipul MedCorp Insurance TPA Private Limited took more than 6 hours to settle the claim which created unnecessary anguish and inconvenience.

I would request you to kindly appropriate action against Vipul MedCorp Insurance TPA Private Limited for this negligence on their part and advise them to reimburse me the difference amount of Rs.19, 881/- immediately along with penalty for causing unnessary mental agony.

The scanned copies of the initial sanction letter and final settlement letter are attached herewith, which are self-explanatory.

Thanking you and soliciting your kind cooperation.

Vishvajeet Chatterjee
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