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Insurance Comp. deducted almost 31% of total bill
09-Mar-2023 (In Insurance Law)
Insurance company had approved the estimation for treatment submitted by Max hospital under Cashless treatment for the surgery. Post surgery, hospital sent the the discharge summary and all related documents / invoices. But due to flood at the insurance company (TPA) location they did not responded and I was forced to pay from pocket. Submitted the invoices to Insurance company for re-imbursement but they deducted the large amount saying Doctor charges not justifiedI have followed for long with insurance company but no luck. If it would have been under cashless, I dont think I would have gone through such a harassment. They have not responded to hospital and my multiple follow-ups post treatment. raised to Ombudsman also but all uselessPlease suggest if I can raise to consumer forum for recovery of same. Insurance company cannot deniy by just saying Doctor charges not justified. Its their empaneled hospital and also approved for the particular diseaseThanksnShailendra Singh
Firstly, a policyholder should approach the GRO of the insurance company. Ideally, the insurance company address the concern within 15days. However, if the grievance is not resolved within 15days or if one is not satisfied with the resolution provided by the insurer then, one can file suit in the Consumer Forum.
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Adv. Parul Singh
Delhi | 25+ Answers
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