Location/place: kolkata
Name of company/service: National Insurance Company Limited
I took admission in the Anandalok Hospital on 22/12/2011 for my gall bladder operation. But before operation the doctor asked me to do some medical test like TMT, stress echo etc. After seeing my ECG report from which he suspects some irregularities in my heart. To make sure from his side at the time of operation,he asked me to do those medical tests. On 21/09/2012 after receiving the claim settlement advise from M/S Medi Assist India TPA Pvt. Ltd. (after a long eight & a half month) I observed that they have deducted the medical test like TMT & stress echo,though the above medical test were very essential which was done according to advice of the concerned doctor (prescription already submitted to the insurance company). On 26/09/2012 I gave a letter to M/S Medi Assist that I made those medical test according to my doctor’s prescription and requested them to review my claim. In reply on 18/10/2012 M/S Medi Assist gave me a letter requesting me to furnish information related to my above claim stating “..please provide the treating doctor’s certificate..” mentioning the justification for advising stress echo,TMT etc. Again on 30/10/2012,I received from them the same request letter “..please provide the treating doctor’s certificate..”. Accordingly,on 31/10/2012, I submitted to them my treating doctor’s certificate,mentioning the justification for doing those tests,such as stress echo,TMT etc. On 30/01/2013,I wrote a request letter to the National Insurance Co. Ltd. ,189/1,Bidhannagar Road,Kol-700067, giving all the details for their information.Again on 25/03/2013,I gave 1st reminder to my insurance office,but they did not give any reply till today. In this situation,sir,what is my fault?I made those medical tests according to my doctor’s prescription,without these tests,he would not operate me. I shall be grateful,if you please intervene this case,so that I may get those two medical tests’ charges.
Deduction made by TPA(M/s. Medi Assist India) from settlement letter dt.21/09/2012 in respect of medical tests like stress echo,TMT which was very essential before operation as per doctor’s prescription at the time of settling the bill submitted on 18/01/2012(claim no. 2178888) under policy no. 104200/48/11/8500004757
Leave a Reply