UNREASONABLE SETTLEMENT OF CLAIM FOR REIMBURSEMENT OF MEDICAL EXPENSES INCURRED

I have a Health Insurance Policy – Gold with United India Insurance Company Limited for myself, my wife and my daughter(Policy No.0307022814P103786998). My wife under gone an operation on 17.05.15 for “4 degree HAEMORRHOIDS” in the United Nursing Home (P) Ltd. at Serampore and she was released from the Nursing Home on 23.05.15. Thereafter, I submitted my claim,(Claim No.HH471600659) and through my agent, for reimbursement of Nursing Home Bill, charges for medical Tests before operation and expenses incurred for purchasing medicines as prescribed by the doctor(s) totaling to an amount of Rs.34592.85. After submission of the claim, additional queries were made by the TPA (Heritage Health TPA Pvt. Ltd.) which were also met by me and certificate from the doctor also submitted. But, to my surprise my claim has been settled for Rs.13336/- only. The TPA has deducted a large amount of my claim in an unjustified manner. I also submitted a further bill for Rs.13496/- (Claim No.HH471600659) (doctor fees Rs.600 + Medicine Rs.446 + Nursing charge Rs.12450) in continuation of the first bill. The second bill has been settled for Rs.1046/- only i.e. no nursing charge has been given. The TPA deducted a large amount of my claim very unfairly. I am feeling that I have been cheated by the insurance company. I request that my legitimate claim for reimbursement of medical expenses incurred by me may be settled in a justified way.