[Resolved] Medi Assist India Tpa Pvt. Ltd. - Mediclaim — Non Reply of Our Letters based on settlement advice sent by them. | |
We have medi claim Insurance with New india Insurance & their TPA is MEDI ASSIST INDIA TPA PVT. LTD. our family policy number is 141600/34/09/11/00004063 & claimant name is vimal Navin parekh WITH MEDI ASSIST CLAIM NO. 1549512 Our above claim is settled by company with a letter mentioned that company will not do any clerification after 7 days of settlement advice letter date. We have wrote 2 letters to this company within 20 days from their settlement letter received by us to their Indiana house Andheri (e) , Mumbai office. However company is not replying to this letters from last about 1 month nor they have put any online status about our letters on their website www.mediassistindia.com under our alloted online access account. This kind of service approach for a ISO certified company is really not appreciated. Company can not take their stand by specifying in settlement letter that they will not clerify anything about settlement amount after 7 days of this letter date. Generally customer receive letter 1-2 days after letter date & it takes some time for claimant to analyze the same. Even sometime some details may be required from hospital to resubmit it to TPA company & it takes time so 7 days limit is certainly not acceptable. Ideally company must reply to all queries of customer & put the status of all such queries online. I think company's ISO standard also do not agree with such policies. Was this information helpful? | |
Aug 14, 2020 Complaint marked as Resolved | |
 7 Comments | |
Comments
To : Medi Assist India TPA Pvt. Ltd.
Claim No. 1720688
MAID : [protected]
Sir / Madam,
This is further to the following email and the documents that were faxed to Medi Assist India TPA PVT. LTD., Andheri office fax number for the expenses incurred towards my father LATE Sanjeeva Shetty
After several attempts could connect to the andheri office on[protected] which is not on the letterhead and i could manage to get from internet. I was able to take up this matter with Ms. Tabassum in this office. Even the office do not know who has signed the two letters received by me. I too do not find any name of the person who has sent these letters. While the transmission of fax of 4 pages is shown okay at my end i am being told that the fax machine is not working and that i should courier my complaint to their office, which they will reply later.
Still now i am not able to understand why the claim is repudiated??? Where is the annexure A as mentioned in the letter???? why the expense cannot be reimbursed??????
When i insisted to meet the Incharge of the office, i am being told that Ms. Vijaya Bhandari is the head and she is not available till monday and that too on monday i should first courier the letter and then callup before visiting the office.
What impression are you giving about your service to the general public - who have gone for mediclaim with the hope that it will come to their help in hour of need especially when i have lost my father.
I am also working on a very responsible position as the head International division for 15years in a pharmaceutical company and i see the attitude of your staff very lax and inhumane.
I am going ahead with taking up this matter with the legal department.
ASHOK SHETTY
Direct Line No. 67739109
Cell No. [protected]
Claim No. 1720688
MAID : [protected]
Sir / Madam,
This is further to the following email and the documents that were faxed to Medi Assist India TPA PVT. LTD., Andheri office fax number for the expenses incurred towards my father LATE Sanjeeva Shetty
After several attempts could connect to the andheri office on[protected] which is not on the letterhead and i could manage to get from internet. I was able to take up this matter with Ms. Tabassum in this office. Even the office do not know who has signed the two letters received by me. I too do not find any name of the person who has sent these letters. While the transmission of fax of 4 pages is shown okay at my end i am being told that the fax machine is not working and that i should courier my complaint to their office, which they will reply later.
Still now i am not able to understand why the claim is repudiated??? Where is the annexure A as mentioned in the letter???? why the expense cannot be reimbursed??????
When i insisted to meet the Incharge of the office, i am being told that Ms. Vijaya Bhandari is the head and she is not available till monday and that too on monday i should first courier the letter and then callup before visiting the office.
What impression are you giving about your service to the general public - who have gone for mediclaim with the hope that it will come to their help in hour of need especially when i have lost my father.
I am also working on a very responsible position as the head International division for 15years in a pharmaceutical company and i see the attitude of your staff very lax and inhumane.
I am going ahead with taking up this matter with the legal department.
ASHOK SHETTY
Direct Line No. 67739109
Cell No. [protected]
G.P. Mathur
3/474, IInd Floor
Dakshin Puri Extension
New Delhi-110 062
Mob:[protected]
Email: [protected]@yahoo.com
Date: August 4, 2010
Medi Assist India Pvt. Ltd.
TPA
Indian House
A-Wing 6th Floor
Marol Naka
Off Andheri Kurla Road
Behind Star TV Office
Andheri East
MUMBAI – 400059
Phone :[protected] / 01
Sub: Unfair trade practice and Gross deficiency in not allowing the claim
Ref: Claim No.4990749, Insurance Policy No.9202/[protected]
Dear Sir,
My wife, Soma Mathur, was firstly admitted in Sawan Nellu Angel’s Nursing Home, Saket, New Delhi for treatment of stone in gallbladder in and around 21/12/2009. She was operated upon. Your Company being TPA for Reliance Health Insurance had given approval for Rs.32, 000/- (approx.) towards treatment of my wife and the said hospital was paid by you. The sample taken from the gallbladder was sent for further biopsy.
Lately upon examination of the sample it was found that an operation of “Incidental Carcinoma gallbladder (post laparoscopic cholecystectomy) is necessary. My wife was consulted in ‘Gujarmal Modi Hospital & Research Centre for Medical Sciences’ by Dr. Harish Kapila and an estimate of Rs.2, 50, 000/- was informed by the said hospital for operation. Instead of getting the operation done in the said private hospital, I opted to go in AIIMS (All India Institute of Medical Sciences), New Delhi for the operation of the said disease. I incurred about Rs.30, 000/- in the Government hospital (AIIMS, New Delhi) and filed claim with all bills & consultation / diagnosis reports in original with your Delhi office on or about 31/3/2010. I followed up several times with your Delhi & Mumbai office and also on their demand sent additional papers. A receipt was obtained by me upon filing of the claim of Rs.30, 000/-.
Contd…p/2
: 2 :
To my utter surprise and astonishment I received a Cheque on 3/8/2010 bearing No.168044 dated 27/7/2010 for Rs.1, 410/- drawn on HDFC Bank Ltd. towards full and final settlement of my claim of Rs.30, 000/-. I being honest to your Company / Reliance Health Insurance went to Government Hospital so that minimum expense is incurred. I paid several visits to the said AIIMS, New Delhi for operation of my wife. I spent my time and money in AIIMS for the operation. The operation which was conducted in the Government hospital i.e. AIIMS, New Delhi would have definitely cost about Rs.2 Lakhs to your Company if done privately. Even in the AIIMS in private wards, it would have cost you about Rs.1 Lakh but I chose to go for general wards to minimize the expense. Still such an unfair trade practice at your end by clearing the claim for a meager amount of Rs.1, 410/- as against Rs.30, 000/-?
I wish to mention here that it is not full and final settlement of my claim as mentioned in your covering letter dated 28/7/2010. Your Company has to still pay me Rs.28, 600/-. I, therefore, request you to kindly send me your cheque for the balance amount at the earliest.
I acknowledge having received the said cheque of Rs.1, 400/- under protest. The same cheque is being deposited by me.
It is pertinent to mention here that in case my balance amount of the claim is not settled within 21 days, I shall approach appropriate forum for redressal of my grievance at your cost, expense and consequences, which please note.
Thanking you,
Sincerely yours
(G.P. MATHUR)
Encl :
1. Photocopy of Letter dated 31.03.2009
2. Photocopy of Letter dated 12.05.2010
3. Photocopy of Letter dated 13.07.2009
3/474, IInd Floor
Dakshin Puri Extension
New Delhi-110 062
Mob:[protected]
Email: [protected]@yahoo.com
Date: August 4, 2010
Medi Assist India Pvt. Ltd.
TPA
Indian House
A-Wing 6th Floor
Marol Naka
Off Andheri Kurla Road
Behind Star TV Office
Andheri East
MUMBAI – 400059
Phone :[protected] / 01
Sub: Unfair trade practice and Gross deficiency in not allowing the claim
Ref: Claim No.4990749, Insurance Policy No.9202/[protected]
Dear Sir,
My wife, Soma Mathur, was firstly admitted in Sawan Nellu Angel’s Nursing Home, Saket, New Delhi for treatment of stone in gallbladder in and around 21/12/2009. She was operated upon. Your Company being TPA for Reliance Health Insurance had given approval for Rs.32, 000/- (approx.) towards treatment of my wife and the said hospital was paid by you. The sample taken from the gallbladder was sent for further biopsy.
Lately upon examination of the sample it was found that an operation of “Incidental Carcinoma gallbladder (post laparoscopic cholecystectomy) is necessary. My wife was consulted in ‘Gujarmal Modi Hospital & Research Centre for Medical Sciences’ by Dr. Harish Kapila and an estimate of Rs.2, 50, 000/- was informed by the said hospital for operation. Instead of getting the operation done in the said private hospital, I opted to go in AIIMS (All India Institute of Medical Sciences), New Delhi for the operation of the said disease. I incurred about Rs.30, 000/- in the Government hospital (AIIMS, New Delhi) and filed claim with all bills & consultation / diagnosis reports in original with your Delhi office on or about 31/3/2010. I followed up several times with your Delhi & Mumbai office and also on their demand sent additional papers. A receipt was obtained by me upon filing of the claim of Rs.30, 000/-.
Contd…p/2
: 2 :
To my utter surprise and astonishment I received a Cheque on 3/8/2010 bearing No.168044 dated 27/7/2010 for Rs.1, 410/- drawn on HDFC Bank Ltd. towards full and final settlement of my claim of Rs.30, 000/-. I being honest to your Company / Reliance Health Insurance went to Government Hospital so that minimum expense is incurred. I paid several visits to the said AIIMS, New Delhi for operation of my wife. I spent my time and money in AIIMS for the operation. The operation which was conducted in the Government hospital i.e. AIIMS, New Delhi would have definitely cost about Rs.2 Lakhs to your Company if done privately. Even in the AIIMS in private wards, it would have cost you about Rs.1 Lakh but I chose to go for general wards to minimize the expense. Still such an unfair trade practice at your end by clearing the claim for a meager amount of Rs.1, 410/- as against Rs.30, 000/-?
I wish to mention here that it is not full and final settlement of my claim as mentioned in your covering letter dated 28/7/2010. Your Company has to still pay me Rs.28, 600/-. I, therefore, request you to kindly send me your cheque for the balance amount at the earliest.
I acknowledge having received the said cheque of Rs.1, 400/- under protest. The same cheque is being deposited by me.
It is pertinent to mention here that in case my balance amount of the claim is not settled within 21 days, I shall approach appropriate forum for redressal of my grievance at your cost, expense and consequences, which please note.
Thanking you,
Sincerely yours
(G.P. MATHUR)
Encl :
1. Photocopy of Letter dated 31.03.2009
2. Photocopy of Letter dated 12.05.2010
3. Photocopy of Letter dated 13.07.2009
To Mediassist TPA
please take reference of claim No. 5666955
we have summitted claim paper on 23 feb 2011 with all paper and MLC to mediassist TPA delhi, but till date TPA raising descripency for MLC paper.
phone was not picked up by executive Dr Faisal and Dr. Alam in Delhi both are like dictator.
we will complain to IRDA
thanks
Rajender Singh Negi
please take reference of claim No. 5666955
we have summitted claim paper on 23 feb 2011 with all paper and MLC to mediassist TPA delhi, but till date TPA raising descripency for MLC paper.
phone was not picked up by executive Dr Faisal and Dr. Alam in Delhi both are like dictator.
we will complain to IRDA
thanks
Rajender Singh Negi
Times Of India — NON REPLY OF QUERY
I have made several inquiries to the officials of TOI through email regarding subscription of the news paper. But I think either they are too busy or they are least bothered about the queries of the customers. I just wanted the subscription schemes available in north-east Delhi. Thanks & Regards. my name is Chandrakanth D and I have a Medi Assist India Pvt Ltd policy through my employer Ref: EmpCode[protected]HCL)
and I have submitted a claim for my hospitalization on 15.12.2013 and submitted a claim on 29.11.2012.
Till today I have neither received the claim nor the company responding to my repeated reminders, even registered letter sent by me.
What should I do to get a relief for my grievance faced by this company and the mental agonies I have gone through
An early action in this regard would be appreciated
Chandrakanth D
Mob: [protected]
and I have submitted a claim for my hospitalization on 15.12.2013 and submitted a claim on 29.11.2012.
Till today I have neither received the claim nor the company responding to my repeated reminders, even registered letter sent by me.
What should I do to get a relief for my grievance faced by this company and the mental agonies I have gone through
An early action in this regard would be appreciated
Chandrakanth D
Mob: [protected]
I was recently in Lilavati Hospital for some problem. I was under observation from 3rd January, 2014 to 5th January, 2014. My agent for medi-claim filed for reimbursement with Medi Assist India Pvt Ltd . I have been receiving queries after queries which are unnecessary and raised just to delay my legitimate claim. But despite my regular replies and follow-up, they are delaying the claim on flimsy grounds. HOW CAN A COMPANY CLAIMING TO BE ISO CERTIFIED BEHAVE LIKE A GOVERNMENT DEPARTMENT AND DELAY PAYMENT. Claim reference number quoted in the letter is 9778585. If the claim is delayed, I will be constrained to file Consumer Complaint and also highlight the issues in PRESS.
Hoping for early response and disbursal of my claim.
Regards,
Mayur V.Shanbhag.
Hoping for early response and disbursal of my claim.
Regards,
Mayur V.Shanbhag.
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+91 80 2658 4811
“Sri Krishna Arcade”, 47/1, 9th Cross, 1st Main Road, Sarakki Industrial Layout, 3rd Phase, J P Nagar, Bangalore, Karnataka, India - 560078
Both Underwriter and TPA to clarify and improve its services to insuring public. Such bureaucratic approach adds to ever increasing pending cases with Consumer Redressal Forrum and Ombudsman.
People have no good opinion for TPAs.