[Resolved]  Medi-Assist (Insurance Company) — Unethical Deduction of Insured Amount

Address:

Hyderabad, Andhra Pradesh

Regarding Serious complain against Medi Assist

Hi,

I would like to draw your kind attention towards a strange issue; I faced during my hospitalization and post discharge process on last week end.

I as a HCL employee covers under Medi Assit insurer with 80% part have to be paid by insurer and 20% by the employee.

I was admitted to Apollo Hospital Hyderabad for two days to get treated for surgery for my degenerated back disc.

Apollo is having following category of rooms -

1) General ward – INR 1350

2) Semi Deluxe – INR 2400 (twin sharing per room)

3) Deluxe room – INR 3500 (Single Sharing)





Item
Amount (in INR)
Remark

Total bill by Apollo Hospital - Hyderabad
104368




Amount Should have been approved by Medi Assist
83494


Actual amount approved by Medi Assist
71534
Medi assit has trimmed actual bill by ~INR 14500 and provided 80% on remaining amount.

Amount should have been paid by employee
20873


Actual amount paid by employee
32834
I had to pay extra ~ INR 12000 because of wrong calculation done by insurer




Medi Assit is asserting that they have ceiling limit of INR 2000 per day. Since Apollo is not having any room with per day charge as INR 2000, I was given the room @ 2400 per day and I assumed that I will pay remaining INR 400 per day by my own.



The Medi Assit have trimmed the actual bill of INR 104368 by a certain amount (~ INR 14500) and have approved 80 % from the remaining amount(~INR 90000), which comes to the figure INR 71534.

Medi assit is asserting that this amount is trimmed because ceiling of INR 2000 per day exceeded and room charges (doctor/nurse visit, other medical services) are much costlier for the high end room. Contrary to their calculation, Apollo hospital administration has given the information that there are no differences on the charges levied by hospital on based on room category. They are ready to provide this particular information on their authorized letter.



MY point is -

1) There is no room with INR 2000 per day in Apollo Hyderabad, so I had to opted for INR 2400 per day room.

2) As per the Apollo hospital administration, there is no differences on the charges levied by hospital on based on room category They are ready to provide this particular information on their authorized letter.

3) This Semi deluxe room was not a luxurious room and it was a twin shared accommodation.

4) This INR 14500 amount trimming from the full bill is totally wrong as there is no differences of medical services among room category.

5) I suffered a loss of ~INR 12000 because of this wrong calculation done by insurer.



I would like to request you to look into this matter and assist me to get back this amount back.