New India Assurance Company / Mediclaim Policy
Discrepency In Acceptance Of Mediclaim

I hold a mediclaim policy with The New India Assurance Company for my mother.

Mem No.: 02I00257923B

Policy No.: 511600/34/08/11/00003362

My mother was admitted in AMRI Hospital, Kolkata for a surgery. The total Bill for the hospitalization was Rs. 1, 37, 825/-. On submission for "cashless" claim, the total permissable claim granted by "Medicare TPA Services (I) Pvt Ltd". Kolkata was only Rs. 50, 000/-. Although the insurance cover for the above mentioned policy is Rs. 1, 50, 000/- with accumulated bonus of Rs. 50, 000/- for 1st 1 lac and Rs. 2, 500/- for next Rs. 50, 000/-

The logic given is that all expenses will be reimbursed basis permissible room rent. Now, if permissible room rent is Rs 1000/- and the actual room bill is Rs. 3000/-, then even surgeon fee would be reimbursed only to the extent of 1/3rd of the expense. Sounds pretty irrational.