Billed Deducted Approved

Expense name Reason of Deductions(if Any)

Amt Amt Amt
Room and nursing resricted to 1% SI
Single Room 9100 1600 7500 Rs,1500/-only payable hence 1600/-
deducted.,
Consultant Charges 3330 0 3330
ECG Rs.890/-,report not available.As
per ailment capping mastectomy
Investigation Charges 6990 890 6100
charges Rs,36000/-only payable.
hence Rs.890/-deducted.,
Cotton Rs,45/-,gloves Rs,1649/-,gauze
pad Rs.540/-,blankets Rs,235/-,mrm
pack Rs.336/-,ECG elecrodes Rs,90/-
Medication Charges 13025 3727 9298 ,black silk roll Rs,125/-,mask Rs.260/-
,micro shieds Rs205/-,cap Rs,120/-
,linen Rs,62/-,soda lime Rs,110/-
,scratch pad Rs.50/-.non payable. ,
Non-Medical Items 450 450 0 Miscellaneous Rs.450/-.non payable.,
As per ailment capping mastectomy
Operation Theatre Charges 51000 41228 9772 charges Rs,36000/-only payable.
hence Rs.41228/-deducted.,
As per ailment capping mastectomy
Pre&Post-Hospitalisation Charges 51090 51090 0 charges Rs,36000/-only payable.
hence Rs.51090/-deducted.,
Co payment 0 3600 0 10% Co payment Deduction,

Doctor Opinion

71/FEMALE D/O CARCINOMA LEFT BREAST, TREATED BY SURGICAL PROCEDURE. CARCINOMA LEFT
BREAST CARCINOMA LEFT BREAST CARCINOMA LEFT BREAST

Regards,
Bhavya.S
CRCM - Dept.
Raksha Health Insurance TPA Pvt Ltd.
18/4, Conran Smith Road,
Gopalapuram,
Chennai - 600 086.
Mob: 9940425838.

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