Panchaayat
OpenComplaint

National Insurance Co. Ltd. / MDIndia TPA - Systematic Disallowance & Rejection Across 6 Hospitalization Claims for Cancer Recovery & Emergency Cardiac Care

National Insurance CompanyPC-2026-02850Insurance ClaimsAnonymous ·
Serious Concern Regarding Health Insurance Claim Handling by MDIndia Health Insurance TPA Pvt. Ltd. I am deeply dissatisfied with the claim handling process of MDIndia Health Insurance TPA Pvt. Ltd. and the distress my family has faced during my mother's medical emergencies. My mother, Girija Srinivas, is recovering from breast cancer. Following aggressive chemotherapy and radiation therapy, she has developed serious heart-related complications. Between January and October 2026, she was hospitalized six times, yet we repeatedly faced partial approvals, claim rejection, unexplained deductions, and conflicting explanations. Summary of our experience:nn- 21 Jan 2026: Bill Rs 67,159 | Authorized Rs 42,327 | Insured contribution Rs 18,117.n- 21 Mar 2026: Bill Rs 1,03,937 | Approved Rs 68,345 | Insured contribution Rs 8,059.n- 30 Mar 2026 - Apollo Hospital, Sheshadripuram: Bill Rs 43,921. Cashless claim rejected, citing admission "for investigation purpose only and not followed by active line of treatment." We paid the entire bill ourselves.n- 4 Sep 2026 - Aster Hospital, Whitefield: Bill Rs 66,993 | Insured contribution Rs 13,169. A disputed amount of approximately Rs 22,000 was attributed to "unnecessary investigations" by customer support, with the hospital and TPA disagreeing over responsibility. The resulting discussions delayed discharge by 2-3 hours and caused significant distress to my medically vulnerable mother.n- 25 Sep 2026: Denosumab injection | Bill Rs 75,803 | Insured contribution Rs 5,106.n- 15 Oct 2026: Emergency cardiac-related hospitalization due to breathlessness | Bill Rs 1,35,103 | Approved Rs 79,338 | Insured contribution Rs 42,258. My questions to MDIndia Health Insurance TPA Pvt. Ltd. 1. Which investigations were considered invalid or unnecessary, and under what policy provisions? 2. Why was a medically necessary hospitalization rejected as being for investigations only? 3. Can you provide an itemized explanation of every deduction and the insured's contribution? 4. Why was our family left caught between the TPA and the hospital during a medical emergency? Health insurance should provide financial protection, not add uncertainty, emotional distress, and financial pressure to an already difficult situation. I request MDIndia and the National Insurance Company Limited to review all six claims, provide written explanations for the deductions and rejection, and reassess any expenses incorrectly disallowed. We have the relevant bills, discharge summaries, and claim documents. If this matter is not resolved satisfactorily, we are prepared to pursue appropriate legal remedies and approach the relevant grievance-redressal authorities. I expect a transparent, documented response and meaningful accountability- ot a generic customer support reply. Insurance Regulatory and Development Authority of IndianR SOUNDARARAJANn #HealthInsurance #MDIndia #InsuranceClaims #PatientRights #CustomerExperience

Reference details

Complainant
***************
Target Insurer & TPA
***************
Patient Details
***************
Regulator Tagged
***************

Source links

History

  1. Case filed

    System · 24 Oct 2026, 4:53 am

Comments (0)

    Log in to comment or upvote.