For patients
Why the insurer paid less than the hospital bill
Your claim was approved and the money is short. That is usually a proportionate deduction, not a rejection — here is how it works, in plain terms.
Why is there a shortfall when nothing was rejected?
Most policies cap the room rent. If the room cost more than the cap, the insurer reduces the associated charges in the same proportion — the surgeon, the anaesthetist, the theatre. Nothing is refused; everything is scaled down. A room upgrade that cost eight thousand can reduce a bill by several times that.
Can I do anything about it now?
Sometimes. If a document existed and was not attached, that is usually arguable. If it is a policy exclusion or an unexpired waiting period, it usually is not. Ask the hospital for the settlement advice and the reason code — you are entitled to both.
Who do I complain to?
The insurer’s own grievance officer first; that step is required. If it is not resolved in thirty days, the Insurance Ombudsman for the area where the policy was issued takes complaints about repudiation, partial settlement and delay. It is free and you do not need a lawyer.
We are not selling you anything here.
Drapto makes software for clinics. This page exists because the question is common and the answers online are poor. There is nothing to sign up for and nothing to buy.
If a claim was cut, you are allowed to ask why.
These pages are written for the person holding the letter, not for the hospital.