Dear Sir: As Per Hospital Tariff We Have Preped Final Bill Kindly Give The Approval I Have Attached Revised Bill Anount Approval

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Cashless Claim Reference Number: (39151389)

(Please quote this reference number in all future correspondence)

E-card Claims Plan hospitalzation Hospitals

Date :10 Aug 2024

To,

The Administrator / Medical Superintendent,


Christian Medical College,
Ida Scudder Road Post Box No-3, Vellore,
Hospital ID: (50212)

Dear Partner,

This is with reference to the Cashless claim (39151389) submitted with the following details:

Patient Details

Patient Name Kavya

Insurance Company United India Insurance Co. Ltd.

Medi Assist ID 5117928605

Policy Holder Tech Mahindra LTD

Treating Doctor Annie Regi

IP No. NULL

Policy No. 0217002823P117712240

Primary Beneficiary Siva Ganesh Arumugam

Employee ID 900167

Insurer Claim No

Insurer Member ID UIIC230086913049001672

Provisional Diagnosis Single spontaneous delivery

We require the following additional information to proceed with the processing of the claim:

1. Kindly provide the revised medical bill/estimate as per agreed schedule of charges /tariff bill As per ailment limit

These documents must be submitted as early as possible to speed up the process of cashless claim pre authorization. Any response received post discharge of
the beneficiary may lead to denial of cashless facility.

QUICK LINKS: DEAR SIR :


For partner hospital AS PER HOSPITAL TARIFF WE HAVE
View this claim on IHX. Not on IHX yet? Sign Up now. PREPED FINAL BILL KINDLY GIVE THE APPROVAL
Upload additional documents online on IHX I HAVE ATTACHED REVISED BILL ANOUNT
For member beneficiary APPROVAL
Track this claim on Medi Assist

We assure you the best of our services, always.

Warm Regards,

Medi Assist Insurance TPA Pvt. Ltd


(Formerly known as Medi Assist India TPA Private Limited) CIN: U85199KA1999PTC025676. Regd Off: Tower "D", 4th floor, IBC Knowledge Park, 4/1, Bannerghatta Road, Bangalore - 560
029.
Helpline: 0120-6937324

Disclaimer: The TPA extends the cashless facility subject to the standard terms & conditions of the policy and the information provided in the cashless request form. We suggest that the
patient continues with the treatment as advised by the treating doctor, irrespective of the pre-authorization/cashless facility.

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