Jain International Organisation [JIO] Complaints & Reviews

I had purchased Mediclaim health policy of Kenko health through JIO organisation. My father was admitted to Symbiosis hospital on 29TH April 2024 and readmitted on 3rd June 2024 IN Sir H N Reliance Hospital. He was diagnosed with TB illness and he passed away on 6th June 2024 in hospital itself. I have submitted all the relevant documents and bills of medical expenses to Kenko health but i received no response from Kenko health as well as No response from JIO organisation. All the expenses I had to bear by taking loans from outside. Initially they said claim would be settled in 30 days post bill submission. Later all vanished. Neither JIO nor Kenko health provided any kind of assistance

Provided below are Order ids(Kenko Health) containing details of bills and necessary documents required for passing the claim
Order ID are as follows :-

4E2DB-[protected]
DT[protected]

361EC-[protected]
DT[protected]

98C5C-[protected]
DT[protected]

001EC-[protected]
DT[protected]

I need full claim amount + compensation for mental harrasment occured in times of health and medical emergency

I have claim id 373084, all the documents are submitted but Jio representative in Ericson Tpa named Bhavik jain is not processing it and neither he is picking up the call or no response.
We are in deep trouble as I have videos of submitting all documents but still it has been said documents are not there .
I have video of all the documents I have submitted but still this is mentally tourtire for us .

My jiojacid is [protected]. I started the jio medical jnsurance services from 2018. Before 3 months i claimed the insurance agaist my father illness. Its been 90 days where every now and then the TPA Kenko health asking query in bits and pieces. So far their is no amount received against claim. Whenever we follow them up they say that it is under process. Pls look into this on priority and help me to get the claim settled

Dear Sir/Madam,
As discussed as well as replied to you couple of times, that the operation/treatment is not only laser but also multiple phlebectomies as well as sclerotherapy. For the same reason we had taken doctor letter on his letter head which clearly mention that LASER treatment cost is 45700 and rest of the hospital bill cost is 119820 rs. (Refer Bill No. 3302). So total amount I had paid 165, 520 rs. I had already submitted all the proofs on kenko app, you can omit as per your rule/guidelines my 45700 rs for laser treatment (Bill No.3304 ) but plz approve the rest of the claim. You know how difficult to talk to doctor for arranging same type of document multiple times, I request you plz go through the attachment doctor letter, discharge summary highlighted part along with bills where it is clearly mention for laser treatment billing is different and for others it is different. We had taken this policy just because of Jain community and its faith with the patient, I request you plz do the needful waiting for your positive reply.

Dear Sir/madam,
Thanks for rejecting the claim, now I came to know why most of the jain community people rejecting this policy. First of all till date you had never sent us a physical copy of insurance policy which is mandatory as per law. Second thing there were very low response on phone, only email is working which also take almost 20-25 days for the first response by that time doctor wont support for additional documents. Its really lethargic and now onwards I will make sure and also advise to other people don’t take this policy. You as a team making sahebji name worst. Its really one of the most worst experience I find out. Really great mistake was happened from my side.
All details i can share you this is just last communication.

Very silly query of 2 original receipts of rs. 20, 000 not submited. I send copy which provide by hospital but comoany said that this is duplicate receipt, so we can not procesd your claim. And close my file.my policy running from 2015 to oct 2022, my father hospitalize on dec 2020 and i submitted all documents intime. So solve my query as well as possible.
[protected]
Ericson tpa, universal sompo

Repeted Sir

ordes Id [protected]

Patient lalit gandhi (62y.male) adwmtted in hospital (UNMehta Ahmdabad) for Angioplasty (Pumping is low 25%)

Docter Said Angioplasty needed but before that Some test is performed like Eco and Stress thallamud test if Report is, ok so we do Augioplasty (2 stent Muiltivessles) But unifortumately both roport I not
ok (ECo is only 20%. stress thallmus test perfirmed poor fusion in Heart Chamber.
That's why we admitted 3 days for observation cz patient is not stable.

Agressive Medical Managment is mentioned in discharged summary.

Please see attached document, and do needful as soon as possible.

Given contact numbers on site not working. Then where should we contact you.?

My mom and dad has filed claim with Jio via Agent but they have not approved claim. Mom and dad are senior citizens
Please can you help .Dad phone no is [protected].
Thanks,
Sapan

This mail is regarding claim of Mr. Roshanlal Jain & Asha R Jain. The claim status now is being shown as rejected with no valid reason for it. I have attached the reason which was given for rejection as well as I am writing all the claim process done by us.

1. Intimation mail was sent on 1st April 2021(5:13 pm)from [protected]@yahoo.com to [protected]@ericsontpa.com

2. On same day i.e 1st April 2021(5:49) mail for intimation was sent with proper format which was received from [protected]@ericsontpa.com

3. The hospital was not available in the system so we were asked to provide valid document for the same. For which we send the documentary proof with hospital address mentioned.
Date :- 1st April 2021 (8:05 PM)

4. Now for The above three we received a mail that Claim intimation has been received on 26th April 2021 which is 25 days after the intimation was done. And in the mail it was mentioned Claim intimation date as[protected].

5. The Claim intimation number recieved at that time are as follows:-

Roshan lal Jain - 139891
Asha R Jain - 139892.

6. Once we received the Claim intimation number we collected all the documents and send the Soft copy of the documents.

7. But there was no reply for the same so we called the Jio team and they said to Send the hardcopy to the given address for the Claim Procedure.

8. When we gave the Hard Copy of all the documents we received new intimation number for the same Claim which were :-

Roshan lal Jain - 147427 (CLAIM APPROVED ON 21/02/2022)
Asha R Jain - 144803

9. While Checking the status of Claim from all the Claim intimation number. Claim status was

1. 139892 - Status - CLOSURE
2. 147427 - Status - APPROVED ON 21/02/2022
3. 144803 - Status - REJECTED
THE REASON MENTION FOR REJECTION WAS THAT CLAIM INTIMATION WAS NOT DONE WITHIN 48 HRS OF ADMISSION WHICH IS NOT THE CASE. AS WE HAVE INTIMATED ON[protected] AND DATE OF ADMISSION WAS[protected]. THE MAIN THING IS YOU HAVE GIVEN CLAIM FOR MY DAD AND NOT FOR MY MOTHER AND THE INTIMATION WAS DONE ON THE SAME DAY (01/04/2021)

I have attached the screenshot of all the Claim intimation number in the mail.

My claim no. 226237. I have called multiple times Ericsson TPA call center team and they were all telling lies and everytime give new timelines and saying that it is on hold. Please do not take this policy ever . They are fraudsters.

I am renewing Mediclaim policy for the JAC number - [protected] and for that i have initiated payment amounting Rs. 44, 523.60 on 27th March 2022 at 9.52 PM. The same premium amount is deducted from my bank account but the transaction shown was unsuccessful and my Mediclaim was not renewed. After waiting for 2 days I have again initiated payment from another bank account and it was successful. But till date I have not received a refund amounting Rs. 44, 523.60 which I have paid on 27th March. I am trying to connect to all the numbers which are showing on websites and messages. But unfortunately none of the numbers are working. From somewhere i received one contact details on which I have communicated on[protected]. I am calling 5 times a day since last 1 week but they are also not responding. I have reminded 11 times on mail but no revert. I need my money back on an urgent basis since I am in need of money urgently. Please refund ASAP.

Please help me to refund my hard earned money on urgent basis.

पेशंट का हार्ट का ऑपरेशन करवाया हे। इन्शुरन्स कम्पनी वालों ने बहोत जादा परेशान किया । डाक्टर जब पेशंट क़ो बताके चला गया की डिस्चार्ज होगाय हे । उसके बदमे १.५ दिन तक इन्शुरन्स कम्पनी का क्लेम का जवाब नई आया । क्लेम का प्रॉसेस हॉस्पिटल ने २८ मार्च क़ो ही स्टार्ट कर दिया था लेकिन ३० मार्च की सुबह तक कोई जवाब नई आया । और २८ मार्च से ३० मार्च तक कम्पनी ने पेशंट के रेलटिव को बहुत परेशान किया कोई जवाब सही से दिया नई । कम्पनी के स्टाफ़ क़ो पूरी इन्फ़र्मेशन ही नई थी सबका रिकॉर्डिंग किया था फ़ोन का । बदमें जब फ़ाइनल क्लेम का समय आया तो कम्पनी वाली ने कम पेमेंट भेजा । सूरत में महावीर हॉस्पिटल में रोज़ के हार्ट के बहोत आपरेशन होते हे । हॉस्पिटल वाले ने बोला जिसका डिटेल्ज़ आज तक कोई कम्पनी ने नही मंगा वेसा डिटेल्ज़ माँगा ।

क्लेम भी बहुत लेट पास किया और पेशंट को हार्ट के ऑपरेशन के बादमें और उनके रेलटिव को इतना परेशान किया और क्लेम भी कम करके पास किया (2.56 lak सामने सिर्फ़ 75Hazar पास किया)

अगर पेशंट का इन्शुरन्स करा हुआ था लेकिन क्लेम के टाइम पे इतना परेशान किया और पॉलिसी के हिसाब से eligible amount भी पास नई किया इस वजह से हमें कम्प्लेन लिखना हे और हमें इसका सलूशन चाहिए ।

हमारे पासमे कॉल पे बात की हुई थोड़ी बहोत रिकॉर्डिंग हे । पेशंट के रेलटिव को थोड़ा बहुत समज आता था इस्लिए इतना भी क्लेम पास हुआ नई तो कम्पनी का तो कोई इरादा नई था क्लेम पास करने का जिस तरह से कम्पनी को १०० फ़ोन करने के बादमे भी एक जेस जवाब मिलता था । हॉस्पिटल वाले ने बताया की कोई कम्पनी वाले इतना परेशान नई करते हे ।

हमें जल्दी से इसका सलूशन चाहिए ।

Dear Sir,

I am the registered member of JIO with JAC Id as [protected] and got my Jan 22 renewal for 2022-23 having my policy no 2839/65853497/00/00. ( JIO Jac Id: [protected])
Actually due to oversite I had deposited 33800/- on 5th Jan 2022 to JIO's Axis bank Account no ending 4012 via NEFT from my mobile for renewal of the policy but some how after paying i came to know that from this year onwards there is change in system of paying directly to insurance co universalsampo via portal link so this excess payment of 33800/- is due for refund in full to my account and still awaiting.
Further I had written for the refund to JIO via emails with multiple follow-ups with no revert. My request is to pl help us to get connected with the right guy at the JIO office to whom we can meet and re-submit the data and we get our refund back.
Pl call on my registered number and will follow you. our email id is : [protected]@yaoo.com
Will really appreciate your help help

TPA hasn't processed my father's Medical Insurance claim after constant follow up through emails. It has been more than 3 months since the claim documents are submitted and received by them.

I have submitted my father Cancer treatment medical claim with Ericsson tpa. It has been 2 months since the claim is not processed yet.

My jiojac id [protected]
i make payment rs.16400/- dt25/10/2020
pl give me my polic doument
kamlesh shah/shilpa shah
polic numer-

I’m complaining about the reimbursement claim which we have been following up patiently for more than 2 months. Post hysterectomy, it was clearly mentioned as cancer (malignant) and chemotherapy documents were also submitted.

My question was simple, when malignancy is detected and chemotherapy docs are shared, on what basis capping is provided for hysterectomy and not cancer

The insurance team has been providing lame/repetitive mails, instead of solving the issue.
Discharge summary was also submitted, which clearly states the the surgery was malignant tumour.
Insurance company 6Saal Jio cannot reply what suits them and put the patient to irreparable loss.

Claim id 197657 of SHASHI BALA JAIN we are facing the problem in receiving
claim amount of reimbursement for more than 1.5 months we are your customers if thats your way of working i will appologies to ericson as well as yoy

Ref Claim id : 160035- Post hospitalization documents were submitted within 60 days elecronically as the web site of ericson TPA says to submit. And I asked to confirm if these were in order and ok. On delay in settlements I was told to send paper copies which I sent. Claim rejected due to delay in submission.
No where in home page, policy or anywhere does it say:

1. Hardcopies have to be submitted
2. Pre and post bills are allowed for a period 60 days of discharge, it DOES not mean that is the due date for submission. No where does the policy says that post hospitalization papers have to be submitted in 60 days. If I have a bill on 60th day of discharge, how can It reach you on 60th day.
No responses on emails by TPA as well as Broker Edelweiss and all calls to TPA states we shall respond and never respond

Mansi shah admitted in lokur hospital & all documents provided by do doctor are submitted but claim was not cleared
Why do you want duration of illness by docter we should not provide because we are far away 400 kilometres from hospital now. Pl check & reply