Mediclaim Complaints & Reviews

Cashless denied for My dad, cancer is detected just 20 days back.
With no proper response from agent and company both. Request you to please look after this on Urgent basis.

Dear sir / madam,

I am working in it complany, chennai,
I have submitted the claim for rs 98, 000/-
Received claim amount only rs 71, 000, but amount paid by corporate is: rs.89, 000/-
Still 18, 000/- pending from that claim. Sent many mails to "rn. [protected]@marsh.com" chennai team.
Now they are telling like pre-hospitalization bill date and reports date is mismatching, just one week difference is there, how could it possible all the tests on same day? Taken around 1 week for complete all the tests. You people may know about cancer treatment, many investigations done before treatment. Impossible to complete all the tests on same date.

Excess of eligible category of room rent & nursing charges deducted under charge type 'investigation & lab charges'.
Again deducted excess of ot charges for the eligible category of room rent & nursing charges from surgery charges.
I received only rs.71, 000/-, please kindly check and process my claim for pending amount.

Kindly do the needful at the earliest.
Thank you

This is to inform you that i have submitted one mediclaim case is no 14120754 it's been continuous flowup since two months with mediassit but inpaction report has been pending from company end and no one is helping about the said case. I am fail to understand what kind of services are you giving in such etmeed organization this the worst service i ever had.
Kindly process the settlement or i will write to nodal officer of mediassit india and escalate the matter like anything.

Sir, me rajesh goyal ne indian overseas bank ke marfat emeditek company ki mediclaim policy le rakhi h aur me 7 july 2015 ko mahaveer cancer hopital me admit hua tha tab se mera claim aapke yaha book he but abhi tak query ke alawa mujhe kuch nahi mila he aur mujhe bharose me rakh rakha he .mene logo se paisa udhar leke hospital me paisa jama karaya he but abhi tak koi payment ka rasta aapki taraf se najar nahi aa raha he . ab ya to mujhe consumer court me jana chiye ya media me ye aap hi bataye kyuki meri marne jaisi halat ho rahi he jisme logo ka karja itna badta ja raha he jiska mere pass koi ilaj nahi he . mera cliam no.[protected] he aur name rajesh goyal he . ab aap ya to mujhe mera claim pass karo ya mujhe majbooran media ko aapki isththi batani padegi aur consumer court ka darwaja khatkhatana padega.. rajesh goyal [protected] [protected]

Respected Sir, My mom rashmi garg is hospitalized on Monday (Mohan hospital, bulandshahr) . As she has a cashless card (policy no[protected],[protected], I presented it to the hospital. they generated a bill and sent a bill to TPA (paramount health care), but till now they haven't paid my mothers bill . The hospital is constantly harassing us for the payments . please see in this matter or I will take help of consumer forum, legal help . I have constantly paid premium for the policies from 2010. I think Max life played a false game with us. Thanking u yours truly Aishwarya Garg s/o Rashmi garg policies[protected],[protected] Max life insurance

P/171100/01/2014/012323Policy No STAR HEALTH AND ALLIED INSURANCE CO LTD, Annual preium paid Rs 21050 Medi Classic IndividualType of Policy policy taken under sr. citizen category, where claim will be 70% company's and 30% ours share. While disbursement they gave didnt give as per the commitment. we spent a lot on his operation, and request you to kindly get what is the rightful...

P/171100/01/2014/012323Policy No STAR HEALTH AND ALLIED INSURANCE CO LTD, Annual preium paid Rs 21050 Medi Classic IndividualType of Policy policy taken under sr. citizen category, where claim will be 70% company's and 30% ours share. While disbursement they gave didnt give as per the commitment. we spent a lot on his operation, and request you to kindly get what is the rightful amount. thank you rajyashree [protected] mumbai [protected]@hotmail.com

Dear Sir / Madam Good Morning Hope you are doing good I had filled a claim for my hospitalisation with RAKSHA TPA, Insured with Oriental Insurance Company. Claim had original hospital bill. I have completed my surgery on May1st 2014 in Navsari Gujrat with Dr Snehal Desai Hospital, handover all the original bills including cheque to my agent Mr Ganesh K Khanvilkar Dated : 7th May 2014. Am regularly following up for my mediclaim which is now almost more then 5 months till now their is no reply from Oriental Insurance Company and Raksha TPA My Policy Number : 121700/48/2014/4539 Claim Number : 556214/150/25061 Raksha TPA Number :[protected] Nobody even care to pick up the phone ) I be grateful if you can consider my application & help me out with the best possibility way very urgently, I have also enclosed attachment of my claim with Raksha TPA Stamped Mine Contact Number : +[protected] Email Address: [protected]@gmail.com Thanking you Best Regards Vispy C Master

I purchased on line smart health Insurance policy (Rs.500000 coverage) no. J0002708 from Bharti Axa General Insurance Co. Bangalore, for my son Vishwanath Kamble. Policy start date 03.12.2013 and valid up to 02.12.2014.I admitted my son to Hospital(Purohit Clinic, Panvel) for right soulder dislocation problem, to carry out the surgery. We submitted required papers from Doctor to TPA, Emeditek, Gurgaon, Haryana for prior approval to carry out surgery. All clarifications/justifications provided to TPA (Emeditek) & Bharti AXA GI, Bangalore wide emails from hospital. Surgery carried out on 29.07.14 & was in hospitalized up to 31.07.14. TPA & Bharti Axa Co. requested to submit final bill (Rs.78000) from hospital with discharge summary. Everything required documents submitted to both of them on 31.07.14. First of all both parties were refusing of receipt of documents & every time when we call them, there was no satisfactory reply from them. I was continuous on phone with them for 4 to 5 hours to trace out the submitted documents to both parties. After lot of follow up finally they refused the claim & sent a email to Hospital to recover all bill from patient Vishwanath Kamble. It was surprise to me at the final moment they refused my claim. when we put all papers for claim on 27.07.14, they have not told that we will not get the claim. till final moment they asked all papers, bill, health summary, & we given all clarifications. I am very upset due to such type of behavior of this health Insurance Co. & TPA & caused lot of mental upset to arrange Rs. 78000 from others to pay bill of hospital at the last moment.I would like to highlight to other persons/public beware from such type of Co. & TPA, those who are cheating to innocent peoples. when we apply for policy, they will not come out their policy drawback, terms & conditions.But when we pay an amount for policy to them then, they words the policy as per Co.benefit terms & conditions, which are all against to general public who buy the policy. Request to look into this case seriously, so that other innocent poor, middle class people will not be cheated in future.

This is the very worst experience with the Heritage Health - Chennai centre.

- Not responding in the standard manner and they do not know how to speak with the customers who are discussing important matter.

- Always having an objective to cut the call rather than resolve or answer the query.

- For the past week, I have called around thirty times to resolve a single query but still I didn’t get a proper reply from them.

Dear Sir/Madam,

This is for your information that we are your customer and we have a medic lam policy since 02 years with you current policy no is P/201114/01/2012/004634 problem is that we do not have a smart card my or my family members in 02 years i given all photographs three times but card not came, recently i given the all photographs to Mr Govind Nawle this is your employee but no feedback from him about smart card.

Finlay i am very very upset kindly look what service you give to your all customers after this mail if i am not received any response from star health so i take lea gel action and complaint to consumer forum.

Waiting for your immediate response.

Rajneesh Mishra

[protected]

The Divisional Manager,
United India Insurance Co. Ltd.,
Divisional office No. 7, Jamna House, 3rd floor,
Padam Singh Road, Karol Bagh,
New Delhi-110005.

Reg: Hospitalisation Claim No. 1905763 under SENIOR CITIZEN Policy No. 040700/48/10/97/00003863 of Mrs. Naresh Sethi.

Dear Sir,

A Hospitalisation Claim for Rs.49065.00 for having incurred expenses towards CATARACT
Surgery from Sardana Eye Institute was submitted to the MEDI ASSIST INDIA TPA PVT. LTD
complete in all respects on 29.3.2011 as per their receipt marked C -32.

On 4.4.2011 a SMS was sent by LM-MA on my mobile no [protected] which read as “ Clm no 19 05763 Received on 4.4.2011 (actually received by them on 29th March) is denied . Please refer to
Repudiation Letter” but no such reference letter was received by me.

However, when asked about the reasons of denial of the above claim, we were told to contact your
Office. We, accordingly, after repeated telephonic talks / visits at your office and after coming to know about the reasons of denial of the above claim, the Senior Executive Mr.P K Arora of the above office got a letter issued on 21.6.2011 to the MEDI ASSIST INDIA TPA PVT. LTD reiterating therein the contents of their earlier letter enclosed/submitted along with the claim papers that the above-said Policy is running without break as per details given below:

260300/46/06/8500000/97 NATIONAL INS CO LTD wef 12.3.2007 to 11.3.2008
221600/48/07/41/00003531 U I I CO LTD wef 12.3.2008 to 11.3.2009
221600/48/09/41/00000328 U I I CO LTD wef 12.3.2009 to 11.3.2010
Q 00009141 Bharti A XA Gen Ins Co Ltd wef 12.3.2010 to 11.3. 2011

The above letter dated 21.6.2011 issued by UII Co. Ltd. addressed to the MEDI ASSIST INDIA TPA PVT. LTD was handed over in person to them on 21.6.2011 duly acknowledged by them.

To my utter surprise, I am quite pained to write to you that the above TPA , vide their UNSIGNED letter Dated 4th July, 2011, have again informed me that the claim is repudiated as per policy term & Conditions and have not accepted the continuity of the above policy despite having confirmed by UII Co.Ltd as per your letter dated 21.6.2011,a copy of which has been endorsed by them to your office.

However, we, for the sake of your convenience reproduce below the contents of their letter dated 4.7.2011 addressed to me and copy sent to your office:

“The undersigned has gone through this claim file in detail. This claim pertains to Naresh Sethi covered under SENIOR CITIZEN MEDICARE POLICY for the expenses incurred in the Sardana Eye Institute. As per terms and conditions of the Insurance Policy expenses related to cataract is not payable for first two years of policy inception. Hence, under exclusion clause 4.3 o[censored]IIC, this states that the continuity of policy from UIIC only is necessary for minimum of three years. Hence, this claim is repudiated as per policy term & conditions.

In case you further facts or information to substantiate in this claim, please forward the same to us.”

From the above, it gives me an impression that I am being befooled/misguided either by
UNITED INDIA INSURANCE CO. LTD or by the TPA MEDI ASSIST PVT.LTD. The very purpose of confirming the continuity clause of the policy by the parent Co. who issued the policy and then issued a letter stating that this policy is insured with Divisional Office N0 7 since 4th years WITHOUT BREAK (enclosed and marked page no.3 with the claim documents) and confirmed again the said contents about the continuity vide UIIC Letter dated 21.6.2011 gets defeated, which is a clear case of BETRAYAL. It is a clear cut case of wilful denial of the claim by way of misinterpretation/twisting of facts as per convenience by TPA.

It would have been in the fitness of things if the TPA Medi Assist PVT. LTD, before denial of the claim, would have taken up the matter with you in the light of the facts that the reason given by them for denial of the claim is in total contravention of the facts given by UIIC, in terms of which the above claim is payable as per rules and in no way the above claim can be denied to me as at the time of renewal of policy I was assured that I am eligible/entitled to the claim as such for the cataract surgery.

Kindly take up the matter with the concerned TPA and get the claim passed without any further loss of time as the issue of payment of claim has already been delayed considerably else I will be constrained to adopt another course of action.

We are endorsing a copy of this letter to Medi Assist India TPA PV T. LTD for their reconsideration of the matter in the light of the above facts.

Thanking you,

Yours faithfully,


(Mrs. Naresh Sethi)

Dear Sir,

I have done my spinal operation in paschimi hospital on 13/11/2010, I send my file for claim on 20/11/2010 they have not clear my claim , requested your help in the matter ,

Policy detail mention below.



The Oriental Insurance Co. Ltd.
Policy No:124500/48/10/3904
Corp Name : Development Credit Bank Limited
Name : Devi Datt
Emp Number : 4966
Member ID : O5564966DCBL Age : 34
Relation : Self Sex : M
Valid Upto : 31-Dec-2010
* This card is for identification purpose only.
Toll Free No. [protected],[protected]
24 Hours Help line
Faridabad[protected],2564248
Fax[protected]
Mumbai[protected]
Banglore[protected] Chandigarh[protected]
Jaipur[protected] Kolkatta[protected]
Lucknow[protected] Ludhiana[protected]
Chennai[protected] Kolkatta[protected]
C/o Escorts Corporate Centre, 15/5 Mathura Road
Faridabad Haryana 121003 Fax No :[protected]

Dear Sir/Madam
My self Rajeev Ranjan Singh my Claim No. CLI/2011/171116/0065139-G (STAR HEALTH )is - I have already submitted doctor''s letter ,requested by Star Health so as to releave complete payment. My concerned. Dr have already provided a letter stating that the medication and
hospitalization is done for infection which is not a pre-existing disease.there were some confusions at Start Health regarding Pre-existing disease and they asked me to send a doctor''s confirmation letter stating the details of treatment,I've already submit all of thats paper.I'm suffering from very poor condition because I've taken loan from friend circle, for treatment. because the company had declined for Cashless.

Thanking You
Rajeev Ranajn Singh
Mail Id- [protected]@rocketmail.com
Mob: [protected]

Myself Anand Ladha, a mediclaim policy holder for my family from Instant Helathcare Private Limited issued by United India Insurance from last four years.

The Details of TPA ID is as follows:

Anand Ladha:6901081
Sonal Ladha:6901082

I Requested for remiburement of claim of my wife for pregnancy.My Wife got discharged from hospital on 22.05.2010 and reimburement claim was filled with Emediek on 28.05.2010.The claim Ref NO. is 15807437 in name of Ms. Sonal Ladha

On 10.06.2010 i recieved a letter for submission of some additional papers like photo ID proof and USG report which was submitted by me on 12.06.2010 to your office at GUrgaon.

From that date till now i am calling your customer care,toll free no,either they don't pick up the phone even after calling 100 times or disconnect the phone when i request for claim reimburement status.I even send the SMS as given in website but no response for that also.

I am not knowing my claim status and my reimburement has not been made till date even after considerable lapse of time.

I request you to kindly intervene so that the whole process is more simple for aam aadmi.

Hello,

My name is rahul bawkar my mother having policy with Tata Aig Life Insurance Her policy no is C[protected]. my mother got hospitalised in month of january 2010 and we imedeatly file for claim on 7 feb 2010 to Raksha Tpa which is located at 7, Kumtha Street, Ballard Estate, Mumbai- 400 001,this people are not responding us from 1 month, they are keep telling us that file is in process. they even dont update their site regularly.......................pls help me out


Regards

Rahul Bawkar

CCN#4706353 Under Policy No.1901/[protected]
Policy Holder :Hemant Arora Primary Beneficiary:Hemant Arora Claaaaiment Name: Shobha Arora

The aforesaid claim papers according to the rules and regulations are being sent by me through Reliance General Insurance Lucknow Office and Recieved by
Medi Assist on 2.02.2010 For Rs.24000.00.
Despite of sending all the original documents duly signed by operating Doctor company is writing me back to send the original bills. Which is the most surprising part of the foolishness of claiment authority.
However once again I send a letter stating that once I have already sent all the relevant documents in original how come I send you the original once again.
But the most surpring part is, I could no0t hear any response from the company
despite of recieving my letter on 22..02.2010 as per courier receipt
This clearly indicates that company is not intrested in settelement of the said claim.
Under these circumtances I have no option except than to knock the door of the consumer forum.
Here I also would like to highlight that I am continuing this Mediclaim policy For last 3 years and this is the very first claim.
I also wish to say to concerned auothrity that stop promoting your health policy if you are not compitent to reimburse the claim even after 1 or 2 monthths

Yours sincerly
Hemant Arora

, Inspite of submitting all documents of a reputeded hospital, Appolo and alomost 2 and half month has gone but no respose from company, i have visited office of cannught place many times but they say someone in on leave no one is ready to hear my grivance . please help me , i dont know the status of my claim till now .My Mediclaim policy has been taken by my employer that is LIC.

Dear Sir,

i was claim about my abdomein pain last sep'2008 but ttk health care services ltd not clear my claim till now. and nobody reply to my mail reply. and nobody call to me. i am trying 100 times mail but no reply for this company so pls help me.

My card number is = CHE-NI-GH[protected]A


Rgds,
Viral Parmar
Surat
[protected]

we have a policy 112800/34/08/11/00006209 in myname.we have this policy for the past 8 years and are always prompt in our payment.I had to undergo a laproscopic surgery in aug 2009 and after which I had submitted all my original bills to your office,but it has been rejected saying there is no waiting peirod of 2 years.I would request you to please verify the matter again.

Sub: Mediclaim for Mr. Murari Lal Goel, Policy No. HWT[protected]
Membership No. A16171Y with Cholamandalam MS General Insurance Chennai

Dear Sir,

I have submitted a Medical bill of my father for Rs. 18, 700/-, which was hospitalized during 05th-MARCH-2009 to 08th-MARCH-2009 at BHAGAT HOSPITAL JANAKPURI NEW DELHI-110058.

Our Company has taken a Group Mediclame Policy along with all my family members for more than five years with Oriental insurance, ICICI Lombard, Reliance General Insurance & Cholamandalam MS General Insurance Company Ltd, (Photocopy of policies already given at time of renewal of policies)

Cholamandalam MS General Insurance, Chennai have denied my claim, on the basis of pre existing disease & policy discontinuity, but as per the IRDA norms my father has already been covered under mediclaim from General Insurance Companies for more than five years.

In view of the above the reason given on rejection is not satisfactory & request to reconsider my claim.

I write many times to the Insurance Company, they neither settle my claim nor given me the proper reply. Kindly look into the matter on urgently basic & settle my claim on priority basis.

Thanking you,

for INDFOS INDUSRIES LTD.

Raj Kumar Goal
E-343, Street No. 19
Sadh Nagar Palam Colony
Palam New Delhi-110045
Phone No. 25032640, [protected] (M)

The below mentioned claim is not paid to the hospital till date eventhough pre-approval. Pl send the status of the claim to the above mail ID.

Hospital name: Nandhinee Hospital, Velahcery, Chennai-42. Amt: Rs.22400 Patient Name: Kiranthi Dhanam TTK ID No.KOC-NIC[protected]A Pre-Auth No.:KOC-0708-PA-0000051 Authorisation No.KOC-0708-AT-0000051 DT.4.7.2008

I had filled a claim for my hospitalisation with RAKSHA TPA, Insured with New India Assurance ltd.
Claim had original hospital bill & on query raised even submitted Hospital in house log sheet which was given by hospital (Bhatia Hospital).
In house panel of TPA construed that hospital stay was prolonged hence deducted the claim by all most 25% directly, this means standard given by mediclaim policy issuer company ( The New India Assurance Company Limited) has mandated to all TPA's to deduct 25% of all claims received, those coming back on case to case basis, will be approved or further process per merits.
I need assistance in filling this legitimate case for full recovery as well mental trauma.

Dear Sir/Madam,
Claims submitted against Mediclaim policy to United India Insurance Co Ltd., on 02-3-09 disbursement against which are yet to arrive.

Inspite e-mails/written request to submitted to their respective DO, RO & HO there is no response till date in written consent.

It is only on rigors follow-up according to their “Grievance Redressal System” we finally received claim intimation letter which carried no cheque & thereafter also on contacting for this Inadvertently missed out cheque, so far no response.

For this inconsistent delay, rather regrets we strongly urge UIIC to add Interest charges to the settled amount & then disburse.


Thanks.

Sincerely,

Rakesh Chheda.

I have taken mediclaim policy from your company for my full family with accident coverage also and paying a premium of Rs 20 to 25 thousand approximatly.
I have not claimed any money from last 4 to 5 years one representative of insurence company came and informed me that I am entitled for free Medical check up in any good hospital with full family. How and from where i will get these coupouns. your Madras Genral Manager says free coupouns are stopped by company. which they never informed us.
Please guide us the true facts.
Thanking you
Sunil Arya...

Sir,
On going throgh various complaints -Mediclaim,
may i suggest that `to be helpful, the complaints contain the following details:-
1. Insurers's Name, Office, Addredd postal email, telephone nos. landline, fax & mobile
2.Mediclaim or Mediclaim type policy
All policy with no, period, Sum Insured, Cum Bonus -CB%, Exclusion
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3.With changes coming in all policies, (e.g. from 01/07/'08 -Definition ofPRE EXISTING DIS' has changed)copy of the policy for the relavent period (of claim)
4.TPA-Insurers's Repudiation/rejection/denial/part payment
5.any correspondence between insured & TPA/Insurer

DEAR SIR i HAVE RENEWED MY MEDICLAIM POLICY IN FEB 2008, POLICY PAYMENTS REFLECTED IN MY ACCONT IN SAME MONTHS
IT IS ABOUT 7 MONTHS GONE, I AM NOT RECEIEVED RECEIPTS OF PAYMENT NOR THE POLICY AS ON DATE IT VERY VERY SURPRISING FOR WAY OF WORKING OF SUCH A BIG ORGNISATION

LET ME KNOW THE STATUS AND WHAT TO DO NEXT

THANKING U,

My brother is Chronic Renal Failure patient he has to undergo two dialysis in a week he is an employee of LICI, Jamshedpur Branch his SR No. 328803. Last five months his claim is not sellted with M/s New India Assurance Co, Kamani Centre, Jamshedpur, Jharkhand - 831 001. We are now not in a position to continue his treatment. Moreover the tendency of the officers to harrass the insurer. It is worthwhile to noted that a non-medical professional is checking medical bills prescription and he is not at all aware any of the fact, the bills must be checked by a Medical Practitioner. A complaint has been made on Mr Pinaky Chatterjee, Secretary to CMD of New India Assurance Co, Mumbai on 5th Sept.'08.

Please help us a huge loan on our shoulder.

Regards

Somnath Sen