Universal Sompo — Universal Sompo Health Plus Policy No-2817/52877690/03/000

Health Care Policy No-2817/52877690/03/000
IRDA Ref No[protected]
Above policy is meant to cover Rs. 2 Lakhs
Hospital Bill - Rs 49533/-, TPA approved - Rs 37210/-
Deducted/Unpaid by TPA - Rs. 12323/-
I was admitted in Narayana Hospital (Howrah) & it is their empanelled hospital. Hence, the cost of my treatment incurred by the hospital must be within the scope of mutually agreed terms & conditions. So the claim forwarded by the hospital should have been approved by the TPA. The patient does not directly claim anything. So why the patient is being penalized for any irregularities done by the hospital. Once the patient takes admission in any hospital, he absolutely have no control over his treatment. It is the doctors & the hospital authority to take care of everything. It is beyond my experience that how an Insurance company deny considering the amount levied for consultation, lab investigations monitor charge, consumables and administration charges. I need your good office to initiate suitable action for the approval of full claim.
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Jan 25, 2017

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