Mumbai, India
info@insurancellello.com
Your hospital bill was ₹3,20,000. The insurer paid ₹1,10,000. The TPA cites “reasonable and customary” caps, “non-payable items”, and a hundred small deductions. Each one is contestable.
Short-settlement is the most common — and least challenged — form of claim abuse in India. The denial letter is split into a thousand small reductions: room-rent caps, “non-payable items”, proportionate deductions, customary-charge caps. Individually each looks small; together they can halve your settlement. The IRDAI has specific guidelines on each of these reductions, and most insurers ignore them.
We take the settlement statement and audit every reduction against (a) your policy wording, (b) IRDAI norms, (c) PMR / CGHS reference rates, and (d) hospital tariff documents. Where reductions are unjustified, we file a structured supplementary claim demanding the differential — usually with a 60-70% recovery rate.
A forensic review of every deduction in the settlement statement against your policy and IRDAI guidelines.
Supplementary claim filed for the wrongly-deducted amount, usually 30-60% of the original short-settlement.
Where the proportionate deduction has been mis-applied (a very common error), we challenge and reverse it.
A clear schedule of what is and isn't payable on your policy, so the next claim isn't short-settled.
Share the settlement statement, hospital final bill, and your policy document. We audit within 72 hours.
We mark each reduction as justified, partially justified or fully challengeable.
A structured letter to the insurer's Grievance Officer with citations from IRDAI circulars and your policy wording.
The differential amount is credited. Our fee is a percentage of the additional recovery only — never of the original settlement.
Send us the denial letter or short-settlement note. We will tell you within 48 hours whether — and how — we can recover it.