[Resolved]  Medi Assist — Insurance Claim

Medi Assist Insurance - Cheats Common Man

My name is Madhu Keshava; working in Corporate Company since 2004. Earlier, our company was tied up with TTK Health Insurance and it was really good service we were getting and then the company had to tie up with Media Assist Health Insurance.

My mother is a Neurology Patient. Every now and then, she suffers from continuous hiccups and vomiting. In the month of July, we had to admit her to nearby Sumathi Nursing Hospital where doctors tried their best to diagnose the reason for such issues and failed to find so; they confirmed she needs Psychological Treatment and the same was given. However, Medi Assist denied approving the expenditure. I had to take a loan from my family member and friends to cover up the expenditure.

When checked with the Media Assist Customer Service and Hospital, they claim Medi Assist does not approve expenditure for Psychological diagnosis and treatment.

After a week or so, we found some behavioral changes with my mother’s health and she fell down at home. We immediately rushed to Columbia Asia Referral Hospital where we were told there were the following issues:

01. Sub-acute Left Lateral Medullary Stroke
02. Severe Depression with acute Short Term Memory Loss
03. Left Fifth Metatarsal Base Fracture
04. Numbness in both the ties

MRI Brain scan showed left lateral medullary infarct, was started on anti-platelets, statins with close monitoring of blood pressures. 2D ECHO seems to be normal with an injection; fraction of 60% while carotid Doppler showed no significant stenosis. Orthopedic consult was taken for left leg swelling, X-Ray done showed fracture of left fifth metatarsal base; crepe bandage was applied after the swelling reduced, she was advised to avoid weight bearing.

Other relevant investigations were normal. Psychiatry consult was taken for her acute short term memory loss; she was diagnosed to have severe depression, counseled and prescribed antidepressants.

Pre-authorization was sent by the Hospital and Medi Assist denied the request; which made me to contact them again. I was told by the Customer Service that the approval will not be given on Psychological Diagnosis. Doctor says, “Stroke is more of Neurology Diagnosis and not related with Psychological Issue”. I had to scan the doctor’s copy and fax it to Medi Assist; and had to make some 20-25 calls to get the initial amount approved and confirmed they will not approve 80% of the expenditure instead only 55%.

Medi Assist has an article on “Standard Nomenclatures & Procedures for Critical Illnesses” which says:
“Any cerebro-vascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis in an intracranial vessel, haemorrhage and embolisation from an extra-cranial source. Diagnosis has to be confirmed by a specialist medical practitioner and evidenced by typical clinical symptoms as well as typical findings in CT Scan or MRI of the brain. Evidence of permanent neurological deficit lasting for at least 3 months has to be produced.”

If this is the case, why can’t they approve the complete 80% coverage the dependents are eligible for? I am in a position where I’ll have no option to pay the hospital bill if they ask me to do so at the time of discharge.

Please help me and save my mother…!!!

Mediassist service in Hyderabad is very bad. I have claimed medical bill on[protected]. First I have submitted claim for domiciliary claim in spite of hospitalization. Later I called mediassist customercare anddiscussed regarding this. For that they told me to submit hospitalization claim and to send soft copy of the claim form. Then they will collect bill documents from TCS office where I submitted that documents. I did the same. Now no one is giving update on my claim status.