Mediclaim Claim Escalation - Need Guidance

claim rejection / downgrade cases are increasing day by day .

my heart cries out for those whose hard earned money is digested by these money mongers . 

Room rent must be outside the range allotted.

Was it a delivery case?

Which insurance?

There r some pros for health insurance claims check twitter they can do it for with charge

Read t&c's of policy

this post is irrelevant.. unless u provide with the details of what are deductions made. 

Mata Rani unhe jaldi theek kare

share name of the policy along with policy wording. and for how long its going on and any claims made before?

remarks of deduction: reasonable & customary

Please mention these 2 things, without which nothing will help:

1. Room rent (per day) of the room selected.

2. Room rent allowed as per your policy.

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Now, assuming the chosen room was within policy's room rent range, and charges deducted solely due to reasonable & customary clause, feel free to file a case in consumer court, with charges like:
- no transparency by insurer as on what basis they've unilaterally decided those 'reasonable' charges, yes you accepted their reasonable clause because they forced that consent in a one-way manner, either you accept their condition or remain uninsured, but bigger issue is that they never shared those details and deliberately kept those details hidden until a claim is raised
- no information provided beforehand like what is their reasonable amount list by disease/procedure while buying insurance
- reasonable cannot mean deduction by 63%, and if they're deducting so much it means they're indirectly denying insured people of availing good quality healthcare in private hospitals even though they're taking full premium for full coverage
- Also mention things like room charges, doctor fees, OT fees, etc are all outside your control.

Iske baad 3 possibilities honge:
1. Nobody from the insurance will show up in court on 2-3 hearing dates, in which case you'll automatically be provided financial relief you ask for. And the insurance will probably not renew your insurance next year.
2. You'll win, get appropriate claim amount along with mental harassment damages & legal coverage. And the insurance will probably not renew your insurance next year.
3. You'll lose, but atleast you fought. If you feel this happening halfway, you can try to settle on a lesser amount. And the insurance will probably not renew your insurance next year.

PS: Bhavukta me beh ke don't take advice here & above points very seriously just because they feel nice and logical to hear, consult an actual lawyer. Courts do not work on logical deductions.

Good luck!