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    Please Quote This Reference Number in All Future Correspondence

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    Sameer Mandge

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    Please Quote This Reference Number in All Future Correspondence

    Uploaded by

    Sameer Mandge
    108 views2 pages

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    6343306c-31d8-4932-b8b2-cb70c5f1574f.pdf

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    © All Rights Reserved
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    108 views2 pages

    Please Quote This Reference Number in All Future Correspondence

    Uploaded by

    Sameer Mandge

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Reimbursement Claim Reference Number: (98437000)

    (Please quote this reference number in all future correspondence)

    E-card Claims Plan hospitalzation Hospitals

    Date : 13 Jun 2019

    To,

    Shraddha Mandge,
    Tata Consultancy Services Ltd
    NIRMAL BUILDING, 9TH FLOOR,
    NARIMAN POINT,Mumbai-400021

    Dear Member,

    Your claim bearing No 98437000 against policy issued by The New India Assurance Co. Ltd has been processed for Rs 51338 against the Amount Claimed for
    Rs 55581 towards Medical Expenses incurred for treatment of Single delivery by caesarean section at Chobe Nursing Home, Aurangabad for the period from
    13 May 2019 to 16 May 2019. The details of the claim are as follows:

    Patient Details

    Patient Name Shraddha Mandge

    Policy Holder Tata Consultancy Services Ltd

    Primary Beneficiary Shraddha Mandge

    Medi Assist ID 4022524750

    Policy No. 92000034190400000001

    Relationship with Primary Beneficiary Self

    Employee ID 1576508

    Procedure / Treatment Planned Caesarean section ( LSCS)

    Insurer Claim No TP00392000019900314939

    Insurer Member ID MEMBER900617

    Summary of Approval

    Processed Amount (INR) 51338

    Mode of Settlement NEFT

    Processed Date 13 Jun 2019

    Account Holder Name SHRADDHA SAMEER MANDGE

    Bank Name HDFC BANK

    Account Number 24*********583

    Category-Wise Breakup

    Payable Amount Non Pay Amount Reason for


    Charge Type Bill Amount (INR)
    (INR) (INR) Non-Payment

    cotton60gauze500cord clamp36betadine
    Pharmacy & Medicine Charges 5081 4338 743
    97dettol50

    Consultant Charges 37000 35000 2000 ,break up not enclosed of others rs.2000

    Surgery Charges 4000 4000 0

    prenumbered receipt not enclosed for


    Investigation & Lab Charges 1500 0 1500
    rs.1500

    Hospital Charges 8000 8000 0 ,

    Total 55581 51338 4243

    (LESS)Hospital Discount 0

    (LESS)Copay 0

    Net amount recommended for


    51338
    payment

    You will receive the payment advice once the claim is settled by the The New India Assurance Co. Ltd.

    We assure you the best of our services, always.

    QUICK LINKS:

    Track this claim on MediBuddy


    Learn more about common reasons for difference in claimed and approved amounts
    Read more about reducing cost of care. Plan your hospitalization with MediBuddy.
    Get the MediBuddy app
    Warm Regards,
    Medi Assist Insurance TPA Pvt. Ltd
    (Formerly known as Medi Assist India TPA Private Limited)
    CIN: U85199KA1999PTC025676. Regd Off: Tower "D", 4th floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore - 560 029.
    Helpline: 1800 425 9449 | Contact: medibuddy.in/contactus/

    App Connect
    THIS IS A COMPUTER GENERATED LETTER SIGNATURE IS NOT REQUIRED. PLEASE DO NOT REPLY TO THIS EMAIL

    © 2018 Medi Assist

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