| Address: FIRST FLOOR,RANGOLI SHOPPING CENTRE,NEAR BIG BAZAAR, |
Complaint registration (Bhartiben v rajput / rt. Eye[protected]
1. Name of the complainant: priydeep eye hopsital pvt. Ltd
2. Address of the complainant: first floor, rangoli shopping centre,
Near big bazaar, station road, bharuch-392001.
3. Email id/telephone/fax : mail id: [protected]@hotmail.com / tel no. [protected] / fax no. [protected]
4. Whether individual /company: company
5. Name of the insurance company: the national insurance companyltd.
6. Address of the servicing office/branch: —
7. Policy number/proposal deposit number: 340100/46/17/[protected]
8. Patient name / procedure: bhartiben v rajput / rt. Eye mature cataract.
9. Nature of complaint: non-life against tpa: medi assist india tpa pvt. Ltd.
10. Claim no /al no. : 17277534
11. Details of complaint:
The tpa has less paid rs. 16000/- against committed in claim, till date.
Note: the said tpa was informed to pay rs. 16000/- by mail viz. Date 28/09/2018 & 25/01/2019 but till date we not received given payment.
Portal shows deduction amount rs. 16000/- without reason.
We logged complained at igms dated 21/04/2020, token no.[protected].
Answer from igms : our health team has again reviewed your file and found that claim was processed as per policy terms and condition and rates agreed with the hospital for the surgery. As per agreement for cataract surgery rs.20000/- is payable for surgery. Hope you are satisfied with the resolution. Your grievance is now being closed.
We disagree with above answer due to :
The al issued was for rs.36000/- and mentioned as final al.
The settlement amount cannot be paid lesser then commitment.
Al itself is a commitment for payment. After issuing al at time of settlement one cannot change the terms, it is unethical.
We couldn’t –escalate the complaint due to some technical error.
Date
Matter:
Rs.
26/06/2018
Claim no.: 17277534
36000/-
28/06/2018
Bill no. 1806281
36000/-
Not paid / less paid
16000/-
Herewith find attached copies of above documents.
Awaiting reply,
Regards,
Mr. M. N. Parmar
Administrator
Priydeep eye hospital pvt. Ltd.
Bharuch.
Cell no.[protected]
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