Medical claim not reimbursed by new India assurance
I have a medical claim policy in THE NEW INDIA ASSURANCE COMPANY LTD with policy, however i have applied for medi claim reimbursement with original documents post discharge of my wife from hospital for delivery. The hospital bill is around 1 lakh, but new india reimbursed Rs. 5000/- only.
My wife was admitted in hospital for delivery on 20/09/21, however during admission we applied for medi claim with cashless as my wife is working in another company and she also has a medi claim policy which is provided by their company. During discharge from hospital the balance amount around 65000 paid after medi claim amount Rs.35000/- (cash less) reimbursed by my wife’s office.
During discharge from the hospital I collected all the original bills along with reports from the hospital and subsequently applied for medi claim reimbursement in my company where i have been working. After processing my claim they sanctioned Rs. 5000/- only and credited to my account. Later i was approached the insurance company why they sanctioned Rs.5000/- out of 65000/- which I paid by myself at the hospital.
For the above query they replied, you already claimed Rs.35000/- cash less from your wife policy as she also has a medi claim policy with the same new india assurance company. So you will get Rs. 5000/- as you have an eligibility claim for normal delivery (Rs.40000/-) as they said.
For their reply I raised a query, that me and my wife both are working in different organisations and both have different policies by paying the premiums. Hence we both are eligible for claim from both organisations (part amount by cash less and remaining by reimbursement).
They said in this case, only one person gets the claim amount as per new india assurance policy. For that I asked their company policy copy to know the more information but they were unable to provide the appropriate document and not pay the balance amount