Mumbai, India
info@insurancellello.com
Cashless was denied at the hospital. You paid out of pocket. The reimbursement claim has been pending for 47 days. The TPA keeps asking for “one more document”. Sound familiar?
Reimbursement claims have no hospital pressure on the insurer — unlike cashless cases where the patient is still admitted. So the insurer freely uses delays, document-loops, and arbitrary deductions to wear policyholders down. IRDAI has set turnaround times for reimbursement — 30 days for queries, total disposal within 60 days — but these are routinely breached.
We rebuild your reimbursement file once — fully, comprehensively, every annexure, every discharge summary, every prescription, indexed and cross-referenced — and submit it as a final closed file. We then hold the insurer to the IRDAI turnaround time; if breached, we file for interest at 2% above bank rate, which is a powerful incentive for fast settlement.
A complete reimbursement file in IRDAI-compliant format — leaving no scope for "missing document" follow-ups.
We hold the insurer to the 30-day query and 60-day total-disposal TAT, with interest claimed on any breach.
Full bill value reimbursed (subject to policy limits) — not the discounted figure most TPAs default to.
Where cashless was wrongly denied, we file for compensation under the Patient's Right to Cashless framework.
We list every bill, every prescription, every diagnostic and assemble a complete claim pack with index.
Filed to the insurer in IRDAI-compliant format, with a clear breakdown of payable items per policy wording.
Active follow-up at the 7-day, 14-day, 21-day and 30-day marks. Escalation triggered if response is non-conclusive.
Reimbursement credited with interest if delayed beyond IRDAI TAT.
Send us the denial letter or short-settlement note. We will tell you within 48 hours whether — and how — we can recover it.