[Resolved]  Mediassist Insurance — Health Insurance Denial

Denial of My Health Insurance Claim by TPA Mediassist

Claim No. Received On Policy Number Policy Holder Relation MAID Beneficiary Clm Type Clm Amt App Amt Claim Status
1317653 07 Oct 2008 16:47 710405/34/07/11/
00001826 S S Jeyakkumaran Mother [protected] S Malar Mani Reimburs 23418 0 Denial Reveiw Waited



This is with reference to my claim submitted for reimbursement of expenses incurred towards my mothers treatment during her hospitalization, under individual medical insurance scheme of The New India Assurance Company Limited of which Mediassist Healthcare Services (Third Party Administrator).

I have submitted a claim of total Rs 23418/-, with all the bills and other necessary documents, on 07th October 2008.

After Continuous follow up with mediassist on 4th November 2008 I got a reply by way of a mail that my claim has been denied for reason “T2DM, Costo Chondritis, AGE - med management. Only Investigation done with oral medication” – The treatment is done my Doctors. The purpose of insurance has clearly said that even for a day you admit the reimbursement of hospitalization claim can be made. I really don’t understand why these TPA is denying it

Since then I visited their office in Chennai to reconsider my request many times did not get any satisfactory answer.

After more than a month has passed I finally requested them to return my bills, the customer care executives there failed to give me the correct status of my returning the bills they were keeping on saying that they will send courier but eventually nothing had happened. Finally on January 19th 2008 I have got my bills back.

I had earlier done a claim bearing number 1314619 on 30th September 2008. The hospitalization for this claim and the hospitalization for claim no 1317653 is for same reason but still the TPA has denied my claim after writing several explanation mails to them.

I request you to interfere and get my claims
Hence desperately writing this complaint.

Looking forward for your response - Jeyakkumaran