Mediclaim related issue

Mr.A have a Group Mediclaim policy of Rs.4 lakh through his employer with XYZ Insurance company. ABC company is a TPA for same.

There is capping of Rs.1 Lakh on Maternity Expenses including Pre-natal, Post-natal & delivery expenses.

Mr.A wife got pregent. In 9 month of pregency she had a BP problem & admitted in Hospital. TPA approved the Hospital bill of Rs.70000/-.

After some days in 9 month, Mr Wife delivery the baby.TPA approved the Hospital bill of Rs.95000/-.

Now after 8 months TPA called Mr.A & told that by mistakenly they have approved Excess amount & directed to pay the Rs.55000/- to Hospital.

Is Mr.A is liable to pay to Hospital. What remedy is available with Mr.A



Atleast not by phone call.

Let them write and explain.




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