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RHi everyone!
So my dad recently had to get a tendon repair surgery, and i proceeded with the cashless claim at hospital. A mere 30% was only approved, and the major expense that was not approved was the cost of implants (~55%).
Now, i have been trying to reach out to TPA- park mediclaim- they font pick up calls, sent an email to them, but no response since last 12 days.
Included insurer Oriental insurance but no response from them either.Sent a fresh email to nodal officer of my insurance branch, no response from her since last 4 days.
What are options here to get the claim?
Afaik, TPA claims the implants to be a part of PPN package whereas the hospital denied it to be a part of the same. They denied to share this to me in writing too.1. If someone can enlighten me why implants being part or not being a part of package can be a reason for claim not been given to customer.
2. How can i proceed further to get the claim- any government portals to escalate the complaint before i proceed the legal route.
3. Also, my renewal is due around this time of the year, but my insurer increased the premium prices by 35%. Parents (66 each) are part of policy. Isnt there an IRDAI circular that restricts premium hikes to 10%?Also, i checked the policy wordings, no clause saying implants are not covered.
TIA! Any help/guidance is truly appreciated.
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