MDIndia Healthcare Services Complaints & Reviews

I am raising this complaint to dispute the claim settlement done by md india tpa.
Claim no : 5722269 and 5785483
Patient name : dayaram waman pagare
Policy details: united india health insurance policy for retired employees of bank of india.

I raised a claim for amount of 471388/- but only 134150 amount is settled giving below reasons:

1. Rs. 183074 : usual & customary :as per maharashtra gr claim payable upto rs.134150 /-.

2. Rs. 85000 : visit & doctor charges already charged hence seprate charges not payable under reasonable and customary charges.
Query — this was a consultant visit charges which were mentioned seperately by hospital but still don't know why it is clubbed with iccu charges.

3. Rs. 30000 : o2 charges already part of iccu charges hence seprate charges not payable under reasonable and customary charges.

4. Rs. 30000 : monitoring charges already part of iccu charges hence seprate charges not payable under reasonable and customary charges.

Dispute on point no 3 and 4 is that this details were provided when requested for iccu breakup and is not seperately but part of the iccu charge. Still these charges are denied stating those are not payable

I am not sure if md india is stating that the patient should not consult any other doctor.

I have repeatedly requested to settle the claim correctly or redirect me to proper greiveance channel but till now have recieved no reply from md india related to greiveiance channel

Dr g chidambaranathan m s mch dnb mnmas dorth
medical director
nathan super specality hospital
nabh full accredited
salem tn

dear sir
iam typing from my heart that, tosay iam the owner and managing director off nathan super speciality hospital a nabh fullaccredited hospital-nly hospital in salem district.
our hospital does wor for almost all tpas insurance companies, state and cental govt projects, all tpas aand insurance companies after seeing our good work and papers settle the claims amount in time.
to my surprise the md india tpa who claims the best service holders is not doing any justice for me.
my hospital nathan super speciality hospital is working for government employes and retired employes pensioner s health insurence scheme with tpa-md india and and uiic.
i have serviced early 7-seven cards with tpa md india-uiic from 2019 december toa value of 3.25 lacs and money not transfered for the claims bill sumitted to md indi whho is lethargic, irregular in respnding, resulting in me not paying for the drug companes, iplants, and visiting surgeons and anaesthetics
it is to my surprise the project head me saheeth peeran fails to attend my phone calls, whatsup, messages not once, but huge n of times which makes me to complain to the forum-
first made with md india to get one mr balu who realy wanted to help me since his other peeople could not help him he slowley stopped taking my calls
now iam making the final information to mr sahith peeran head govt rtd employee health insurance,
uiic,
irda,
cmcell,
pmcell,
pm office new delhi,
presidents office, new delhi,
i hope i will get back my hard spent money on md india tpa cards.
thanks regards
dr g chidambaranathan.
nathansuper speciality hospital salem tamilnadu
note-
pending cases 1 sshafir ahamed 39 m ccn no mdi0193334
2parvathi 84/f ccn nomdi41101928
3 vinayagam 72/m ccn nomdi0011722
4kuppusamy ccn no mdi4107013
5vinothkumarccn no mdis-tnehs-[protected]
6lalitha ccn no mdi0215757
7 mathivannan ccn no mdi3004318
pending for more than 10 months.all tpas and insurance companiees and other division of md india are prompt in replying, anking doubts and settle the claims-only rtd govt emplpyee insurence managed by mdindia tpa under uiic is totally not responding .

one mr [protected]@uiic contacted me but refused to reply when i reportedd what he wants.i could not understand why he iis not replying.
thanks drggcn
from dr g chidfambaranathan
nathan super speciality hospital salem tn

TO,
CHIEF MANAGER,
UNITED INDIAA INSURAANCE.CO
TAMILNADU
INDIA
SSUB:-UPDATING OF MY BANK DEETAILS,
DEAR SIR,
MY HOSPITAL"NATHAN SUPER SSPECIALITY HOSPITAL "SALEEM DID SERVICE ON RETIREED GOVT.PENSIONERS NEW HEALTH INSURANCE SCHEME AND MY CLAIMS AMOUNT YET TO GET SETTLED FOR NINE MONTHS.
MY PAN NO IS ADIPC8567H
ROHINI ID IS-UDINO:[protected]
MY EARLIER BANK DEETAILS WERE-
NATHAAN SSUPER SPECIALITY HOSPITAL
LAKSHMIVILAAAS BAAANK SWARNAPUURI SALEM636004
AC/NO:[protected]
IFSC-LAVB0000660

MY CURREENT BANK DETAILS ARE:
NATHAN SUPER SPECIALITY HOSPITAL
STATE BANK OF INDIA, FAIRLANDS

ADVAAITHA ASHRAM ROAD, SALEM 636016
AC/NO-[protected] IFSC CODE-SBIN 0021724
CHEQUE COPY ATTACHED.
SIR,
KINDLY UPDATE MY NEW BANK DETAILS AND SETTLE MY CLAIMS.
THANKING YOU SIR,
SINCERELY,
DR G CHIDAMBARANATHAN,
MANAGING DIRECCTOR,
NATHAAN SUPER SUPER SPECIAALITY HOSPITAL,
SWARNAPURI,
SALEM, 636004,
TAMILNADU, INDIA

Respected sir
here i have come to know you that the above claim is pending from last one and half month from Md India.I have sent all claim papers on 27/07/2020.But they still demands claim papers not received.Sir how can it possible.I have courier receipt also.Please kindlydo some neeful help to me.Thanks

My father Mr. T. Sreehari was appointed in Sunshine Hospitals, Secunderabad on 06.08.2020 for treatment of COVID 19 and was discharged dead on 15.08.2020. The total Bill amount was Rs. 909, 000/-. I'm having a Family Floater policy with New India Assurance Co with a limit of Rs. 5 lakhs. I submitted claim of Rs. 909, 000/- along with hospital bills and other required documents for reimbursement with MD India TPA vide claim no MDI5766939 for MD ID No. MDI5-[protected].

My claim was however settled for only Rs. 318, 737/- with a deduction of Rs. 590, 263/- out of which a deduction of Rs. 376, 392/- was made stating as per Telangana GR deduction done.

Upon enquiry it was known that the Telangana state govt GO No 248 of 2020 was relied upon by TPA. I bring to your learned notice that the said GO was issued by Govt of Telangana fixing a cap on the COVID 19 treatment cost by Private Hospitals. The Insurance companies and TPA are no way connected/concerned with the said GO.

When the hospital itself is providing bills stating that theyhave collected more than the said GO and we have cleared the payment. The TPA and Insurance companies were in no place to fall upon the said GO to make such hefty deduction. The said GO is not addressed to Insurance companies or TPA and it does not provide any guidance to settle the hospital claims.

I therefore request you to kindly reverse the said deduction and settle the amount in full.

My Mother pushpa k had been admitted in shradda polyclinic&nursing home at Mulund west, Mumbai from 21.4.2020 to 28.4.2020.since that hospital was not having cashless claim facilities we had paid the bill of 122, 509 rupees from our own money.Then we had submitted the documents for reimbursement through MD India.Till date we have received about 95000 rupees only through reimbursement. So I request you to kindly look into the matter and help me to get the balance amount of about 27000 rupees as early as possible. MD India I'd no is MD15-[protected]. Claim number is MD15633564, policy number is 500100/28)19/P[protected]. Thanking you, sarala Baskaran,

Good morning sir/madam;
My mother named mrs. V. Jayalakshmi has been planned for hysterctomy (Surgery). Preauthorisation sent from maruthi hospital;cuddalore ;tamilnadu on 19/8/2020. When i called tollfree number on 20/8/2020 they said they did not receive anything from maruthi hospital but on further enquiry they got the mail on 20/8/2020 at 1.45pm. But from the hospital side they called on 19/8/2020 to mdindia insurance office they said they got the mail and they are processing.
Till now no response from md india insurance side. We are waiting here for surgery for 2 days. Till processing is going on only saying from insurance side. What is happening there in your office one person is saying they recieved mail on 19/8/2020 and the other person is saying they did not received any mail. What work is going on there without any communication between office staff???
Now we are suffering because of yours fault

Mrs. Mamta Rani was admitted to Maharaja Agrasen Hospital, Road No 35 Rohtak Road, Punjabi Bagh, Near Shivaji Park
Metro Station, Punjabi Bagh, New Delhi on 22.07.2020 in emergency due to STROKE which caused paralysis to the upper body. The policy in force was from "The Oriental Insurance Company Limited" which was continuing since 05.12.2009 and renewed thereafter every year, latest sum insured Rs.2, 00, 000 from TPA M/s MD India Health Insurance TPA Private limited under Happy Family Floater 2015 silver plan. As per the cashless authorization letter shared by TPA vide claim number MDI5742599 dtd. 27.07.2020, the TPA has approved only INR 25951/- against hospital approval submitted for INR 119676/- wherein ICU charges claimed by Hospital is 6000/- per day and visiting charges 1500/- per day. TPA has made deductions of INR 93725/- wherein ICU/NURSING CHARGES have been restricted to INR 15000/- against inflated amount shown as INR 47500/- for 6 days whereas as per policy the entitlement is 2% of sum insured per day which comes to 24000 and made complete deduction of visting charges and Investigations on proportionate basis i.e. deduction of 68.4% in relation to ICU charges approved. Further TPA has reduced the claim by showing discount of INR 16389/- which was never claimed by Hospital. Despite repeated emails dtd.27.07.2020 we are not getting any response from TPA on said deductions and why the claim is not passed as per limits in policy despite sum insured in INR 2, 00, 000.

I have also lodged a complaint with MDA TPA site, complain number 131496 but there is no response.

This is purely manipulation of claim and unjustified deductions on part of TPA.

Dear……

I am abhishek kumar and carry insuarance from central bank of india. My claim number is mdi5707785 and mdid is mdi5-[protected]. I went for my operation at paras hospital, darbhanga few days back where i was charged 60000 rupees in which only 28000 rupees was covered in insuarance whereas i was told that my insuarance covers 100% of the hospital bill but still i had to pay remaining amount.
I am attaching all the required documents and hospital bills here.
Please look into it as it really means alot to me.

Thanks and regards
Abhishek kumar

My mediclaim card no. Mdi5-[protected] - tamilselvan v
I have applied hospitalization mediclaim reimbursement on 11//06/2020. At chennai office. But i have not yet received the claim amount till date. I have contacted many time there is no response even my mail also. Kindly do the needful as early as possible.

Mail id : [protected]@gmail.com
[protected]

Dear sir,

We have submiited claim through the online lodgment but cliam not ettled yet.

My claim id is mdi5416144 and it was pending from january despite my many calls and mails i always told that it was approved under process through insurance company, i was waiting for my money from last six months in this financial crisis era, your company and employee both harrassed me by taking my call on hold for 15 mintues and then cut the line without giving any reply. It was very painful to inform you when government is taking utmost steps to provide financial support to every citizen while your company and employee both doesn't understand the situation and thought the customer is all free and doesn't take it serious to solve the situation. Call details are feb 12, 21 feb, march 10, march 25, 08april, may 10 and 6june and 9 june, and many mails are there but still not received my claim. So you are requested to please settle my claim or otherwise i have to go in consumer court with all details.

I made claims against my cataract eye operation in the month of december 2019 and january 2020 in your mdindia bhilai office with all desired documents. Subsequently on demand my mdindia some additional documents have also been provided long back.
Repeated requests for early action through mail to all concerned agencies and verbal request to bhilai office has been made number of times, but still it is pending with them without any reason mentioned to me.
I am a ex dgm of bhilai steel plant and my min no is 01415758.
Hopefully, you will look in to my case and get it concluded at the earliest.

Sir,
I am taking follow-up for the above mentioned claim id since 1 year but my claim is stopped for name difference of patient and they required enforcement from insurance company. I had communicated through our bank of baroda hr through email and also personally by call and email many times. I had submitted affidavit signed by executive magistrate for a person with 2 names. But they are not accepting it & not giving document on which they required enforcement. I personally meet here in nashik mdindia office for it, in insurance company office in nashik but no solution received. Company has passed 2 claims for same patient during the period but hold this claim.
Please provide solution for it.
Patient name : kamal dharma bhoge (Kamal kanchankumar khambait)

Yours faithfully,
Kanchankumar ashok khambait
[protected]

Documents submitted claim amount not received
Ccn : mdi5582643 patient : tetridevi dharmaraj prajapati, ic claim number : tp[protected]
Policy number: 160100/34/19/04/00000003
Mdid number: mdi5-[protected]
Claim amount: 41242
The new india assurance company limited
Claim type non cash less
Phone no: [protected]

Ref ccn md 14892472
Sir/madam,
Above claim for rs 24, 609 was sent on 16/5/19 for reimbursement. Operation for cataract operation was done at aiims jodhpur. Accordingly all the documents were submitted as above. Some more documents duly certified by the concerned doctor of aiims jodhpur were submitted on 13/11/19.
I kept on getting the reply that we are processing the case. Now it seems it is not being pursued at your end.
No more documents are required to be sent and no more clarification required.
You are requested to look into the matter and expedite the reimbursement of amount payable.
Shashikala parihar
Shiv pratap parihar

I have submitted a claim of rs 12, 975.10 in the month of nov, 2019 non cash less. I have querried about it, simply they replied as "closed". If it is closed/resolved, my account has not yet been credited with rs 12, 975.10.
Please give me the respective claim number.
I querried over telephone, but they have not replied me the reason of non credit of the amount rs 12975.10, if it is closed/resolved.
My id no - 44318
Mail id - [protected]@gmail.com
M - [protected]
Mdid - mdi5-[protected]

I have applied for reimbursement on 17 march 2019. I have not yet received the claim amount. I have contacted customer care multiple times and also sent the email on [protected]@mdindia.com for multiple times. The only response i used to get from them is payment pending due to technical error. They even don't mention the exact technical error. It's being one year now as of 14 march 2020. I have not yet received the amount and they keep on asking cheque copy passbook copy everytime even thought i have sent the copies multiple time

Md india refuses to entertain our claim for allegedly insufficient documents.
Our contention is that these documents are delivered by the courier and we have submitted the proof.
Inspite of giving the proof, they have refused to entertain the claim.
It seems that these documents have been misplaced or lost by md india receiving office.
This claim is for a sr. Citizen - 78 year old who has gone thru a knee replacement.
Good health policy no. Is[protected] and customer code is: [protected] and patient code is: [protected].
E card no. Is mdi[protected] and mdi[protected].

Pol no -[protected]
Mdid no - mdi[protected]
Policy holder name - ram prasad sahu
Emp id - 044318
I have submitted claim application for rs 12, 975.10 for oct, 2019 with all required papers in the month of nov, 2019, but till date i am not able to know its status. I enquired at his customercare, simply they replied after lapse of three months that it is being forwarded.

R p sahu,
Consumer

My policy no -[protected]
Mdid no - mdi[protected]
Policy holders name - ram prasad sahu
Amount of my claim - rs 12, 975.10 for oct, 2019

I have submitted all the required papers in support of my above claim
In the first week of nov, 2019. Even after two months mdid has not provided me claim number etc. Of my claim and its status, even till today.
When i queried to its [protected]@mdindia, very simply they replied that
We have forwarded your claim to authorisation.