Sir i have taken a Mediclaim policy from National Insurance Co. Ltd – (Mumbai RO – I / DO )-251100 Policy No 51100/46/12/8500001458 claim No.
DHS13Z081640 i have submitted the claim file at 15-Nov-2013 but till now i have not get claimed amt when i call on tpa DHS TPA they said national company is not released
amount i got claim voucher from DHS Tpa but not get my claimed amt. so please u do anything for me is vry helpful because already 1 year is going on this procedure
so please do be needfull for me & give me reason for deduction.
Claim Voucher from DHS
Dedicated Healthcare Services TPA (India) Pvt Ltd.
Office Address:
AHMEDABAD
801, CORPORATE HOUSE, 0PP. TORRENT
HOUSE, NEAR NIRMA HOUSE, OFF ASHRAM
ROAD, NEAR INCOME TAX CROSS ROAD,
AHMEDABAD – 380009
GUJARAT
IRDA License no.28
Email ID: [email protected]
Tel No. : 07940072645
Fax No. : 079-27582645
DISCHARGE VOUCHER
Without Prejudice
To
SEJALBEN I.DESAI
5/B YOGESHWAR SOC; OPP MEHSANA SOC; B/H LAXMI HOSPITAL, NAWA
WADAJ, AHMEDABAD- 380 013
N.A N.A
–
Date : 01-Oct-
2014
Dear Sir/Mam,
As per the instructions of the National Insurance Co. Ltd – (Mumbai RO – I / DO )-251100 the claim No.
DHS13Z081640 is being settled for Rs. 69775.00 on account of ACUTE GE WITH HYPOVOLUMAIC
SHOCK WITH K/C/O DM WITH HTN WITH OLD CV STROKE WITH CKP .
Claim Details: Insured Details:
DHS Claim No DHS13Z081640 DHS ID FA221846895
Admission Date 21-Jul-2013 Ins. Company
National Insurance Co. Ltd – (Mumbai RO – I /
DO )-251100
Discharge Date 23-Jul-2013
Beneficiary
Name
SEJALBEN I.DESAI
Hospital Name
NIDHI
HOSPITAL
Policy Number 251100/46/12/8500001458
Total Claim
Amt.
150057.00 Patient Name ISHWARBHAI M.DESAI
Less: Deductions 80282 Sum Insured 100000
Total Payable
Amt.
69775.00
Bal. Sum
Insured
0.00
Amount Reason
4000.00 Room charge to be restricted to 2 % of suminsured
1000.00 Room and nursing charge to be restricted to 2 % of suminsured
500.00 REGISTRATION CHARGES NOT PAYABLE
3000.00 clause 1b exhausted
750.00 ECG CHARGES.clause 1b exhausted
2100.00 Infusion pump charges NOT PAYABLE
Page 1 of 3
http://125.99.101.58/DHS/Claim/ReimbursementClaimApprovalLetterView.aspx?ClmId… 01/10/2014
Amount Payable: Rs 69775.00 ( Rs. Sixty Nine Thousand Seven Hundred Seventy Five Only )
3000.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
2100.00 clause 1 c exhausted
3200.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
1275.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
2100.00 clause 1b exhausted
529.00 clause 1b exhausted
40.00 DIETORY CHARGES NOT PAYABLE
12950.00 clause 1 b exhausted
17038.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
110.00 thermometer
400.00 adult diapers
1061.00 molinia & handrub & exa gloves & bath wipes
3257.00 211/-gloves(nulife) & urometer AND si exhausted
110.00 thermometer
750.00 bipep mask
5.00 vicks cough drops
5099.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
700.00 rs.700/-bed bath wipes & exa gloves
688.00 molinia & exa gloves
200.00 adult diapers
240.00 wiclenz handrub & rubber gloves
3480.00 DEDUCTED AS SUM INSURED GETS EXHAUSTED
137.00 uro bag & dispo mask
120.00 rubber gloves
2000.00
ROOM CHARGES TO BE RESTRICTED TO 1% OF
SUMINSURED
250.00 DIETICIAN VIsit & SPO2
2000.00
ROOM CHARGE TO BE RESTRICTED 1 % OF SUM
INSURED ALLRADY PAY …. FOR NIDHI HISPITAL BILL
DATE 21/07/2013
150.00 INFUSION PUMP
5943.00
bill not attached DEDUCTED AS SUM INSURED GETS
EXHAUSTED
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http://125.99.101.58/DHS/Claim/ReimbursementClaimApprovalLetterView.aspx?ClmId… 01/10/2014
Note: The above mentioned deductions made as per policy terms & condition & the payment is towards full &
final settlement of your claim.
For any further clarifications, you may directly contact the insurer.
Thanking you,
For Dedicated Healthcare Services TPA (India) Pvt. Ltd
Authorized Signatory
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I SEJALBEN I.DESAI hereby agree that the payment of Rs .69775.00 ( Rs. Sixty Nine Thousand Seven
Hundred Seventy Five Only ) is towards full & final settlement of my claim no. DHS13Z081640. Please
transfer the Amount to my Account in UNION BANK OF INDIA at VADAJ,AHMEDABAD having account
no. 313502010053252 and IFSC Code UBIN0531359
_____________________
Signature of Receiver
Corporate Office: Cambata Building (Eros Theatre Building), East Wing, 3rd Floor, 42, Maharshi Karve Road, Churchgate,
Mumbai-400020
Tel No 022-22675900, Fax: 022-22874235
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