IRDAI 2024 Clause 19 Statutory Compliance
CIO Jurisdiction: Ahmedabad
Award Ref: CIO/AHM/2024
Vadodara Health Insurance Claim Deduction & Cashless Discharge Scorecard
Statutory transparency metrics for network tertiary care in Vadodara, Gujarat • Ombudsman: Ahmedabad
Total Hospital Billed
₹250,000
Arbitrary TPA Cut
₹48,500
Legally Recoverable
₹48,500
Deterministic Math Comparison: TPA Cut vs. IRDAI May 2024 Statutory Math
| Line Item / Disputed Component | Billed (₹) | TPA Cut (₹) | Statutory Approved (₹) | Recoverable Overcharge (₹) | IRDAI Statutory Reference |
|---|---|---|---|---|---|
| Vadodara Average Proportionate Cut | ₹95,000 | ₹23,500 | ₹95,000 | ₹23,500 | IRDAI Clause 19 |
| Vadodara OT Consumables Cut | ₹21,000 | ₹12,800 | ₹21,000 | ₹12,800 | IRDAI Annexure-1 |
Verbatim IRDAI Circulars & Statutory Citations
City Ombudsman Centre — Ahmedabad
Jeevan Prakash Bldg, Tilak Marg, Ahmedabad
Citation: Insurance Ombudsman Rules 2017
Frequently Asked Questions (Pan-India & Vernacular Legal Guidance)
Which hospitals in Vadodara have the lowest reported cashless deduction variance?
Hospitals that adhere strictly to IRDAI May 2024 Clause 19 and refrain from levying unbundled administrative MRD fees achieve over 88% first-pass clean settlement in Vadodara.
Statutory Redressal Jurisdiction: Council for Insurance Ombudsmen (Ahmedabad)
Address: Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, Ahmedabad - 380001
States & UTs Covered: Gujarat, Dadra & Nagar Haveli, Daman and Diu