State Bank Of India [SBI] — claim rejection

Claim id 97886942
Maid:[protected]
Policy no:[protected]-01

Dear sir/madam,

With refer to below mail regarding bill settlement under claim id 97886942, please note our below points which has to be sorted out immediately for this claim
Our total bill amount claimed was rs. 1, 06, 779 wherein the settlement received is only rs. 70, 571; the difference has to be clarified and rectified.
Before hospitalization itself we made clear clarification with the insurance customer service agents 3 times regarding all the charges and bill amount. This it was conveyed to us that for pregnancy and delivery bills coverage, there is no hidden benchmark for the services we utilize or charges we pay to the hospital. It was informed to us that any charges during hospitalization upto the insured amount with the exceptions mentioned in policy documents are payable to the policy holder without any issues.

Here in this case, we need clarification on:
1) why pre natal and post natal bills are rejected wherein its cleared mentioned in the policy schedule/ document that 60 days pre hospitalization expense and 90 days post hospitalization expense are covered.
All the bills provided are as per document within the dates under coverage
Reference — page no 18 — scope of cover — points 2 & 3

2) why our baby bills are not covered wherein its clearly mentioned in your document that new born baby bills are covered within 90 days of being born
Reference — page no 14 — point no 30

3) miscellaneous charges — all the charges mentioned under miscellaneous is under policy schedule. Why it is categorized and not paid? Labour suit charges, baby charges all are payable. As per policy there is no clause that shows this charges are exceptions. So please arrange settlement.

Considering all above points please arrange for our full settlement, where the balance payable to us is rs.29, 135/-