Policy #:OG-13-1000-8402-00000001 Claim #:100061302713 After repeated follow ups Emeditek has declined to pay the balance amount brief details: Cholecsystectmy undergone on 8th June at Peerless hospital in Kolkata after hospitalisation on 7th June and discharged on 17th June.Cholecsystectomy limits as per T&C was Rs 45,000/- , however this limit was only for procedure and not for room rent etc. Pls refer page 9 and page 10 (point 1 and Point 5) of policy document shared with me Page 9 Point 1 says:Maximum entitlement for room rent for metro city is 2% of insured amount, which in this case is Rs 21,000/- Page 10 Point 5 says: In addition to aforementioned cappings , the following capping on procedure/packages shall also be applicable i.e Rs 45,000/- for Cholecystectomy . The amount that was approved was Rs 45,000/- which included both room rent and procedures, however the policy doc differentiates these two and these two heads should have been separately considered and paid up. So Rs 45,000/- was paid only for procedure charges and bed charges were misinterpreted and declined to pay.

Patient is undergoing cancer treatment and in need of finance to support this treatment,pls help to close this as quickly as possible.

Complainant Information
name- abhijitbaksi