Medi Assist India — partially approved by applied customary clause which is not mentioned in policy document

Address: Pune, Maharashtra, 412105

Date of intimation – 5th july 2019. 5th july same day received process documents from kaushal. After analysis of given documents, we decided to do surgery on 13th july and intimated 1 day prior (12th july) before surgery. On 13th july after surgery done we got to know that "reasonable and customary charges and conventional surgery", clause which we did not even aware and introduced this clause suddenly in process. But when they provided documentation when we intimated you very first time, this clause thing was missing completely. Who is responsible for this gap?? They are just illogically replying by giving this clause reference and not replying us on point to point.. Because we have decided to do surgery on basis of process documents provided by kaushal. Note - same clause it not even mentioned in portal -https://portal.medibuddy.in/Home.aspx on 26th july received reply from kaushal said – expect claim processing by 10th aug 2019. Then they extended date to 20th august. Still i was trying to track but no updates are showing on portal. Then again, they extended to next week. 23th august they raised query for 1 document (Prescription letter). 24th august i tried to upload documents online but failed have provided screenshot as well. So as per request but kaushal and brajendra have couriered original documents to the given address. On september 25th i have got to know that they have mentioned that non-pay amount 72179 inr due to reasonable and customary clause applied. And approved only 31734 inr. When i have asked about it, i have been told that why you spent that huge amount? Why you did not visit cashless hospital? What is the use of cashless facility? You should visit listed hospitals, how can they approve some amount based on other hospital cost? We selected best hospital after doing all market review and we can see positive results on my father health which is most important for us. 1. As per kaushal’s first mail, have followed reimbursement process and submitted all original documents for further claim. Out of that i only got single query raised by team about one missing document, and i have sent immediately. Apart from that no other points observed / pending in case of documentation.