Medi Assist Healthcare Services Limited — Violation of IRDAI 2026 Guidelines, Delay in Discharge Approval, and Arbitrary Claim Deductions - Claim No:[protected]

Complaint Details:
I am registering this formal complaint against Medi Assist TPA for extreme deficiency in service and non-compliance with IRDAI regulations.

1. Delay in Discharge Authorization:
Despite all final discharge documents being submitted on[protected] at 4:00 PM, approval was only granted on[protected] at 2:00 PM. This 22-hour delay is a direct violation of the IRDAI 2026 Master Circular, which mandates final discharge authorization within a maximum of 3 hours.

2. Arbitrary Claim Deductions:
The total bill submitted was Rs. 4, 88, 549, but the TPA settled only Rs. 3, 44, 257 without providing any line-item justification for the deduction of Rs. 1, 44, 292, despite all required billing tariffs and breakups being provided by the hospital multiple times.

3. Patient Harassment:
The TPA engaged in a circular "back and forth" query loop, repeatedly asking for documents already in their possession. This negligence forced my father—a senior citizen and heart patient—to remain in the hospital an extra night, causing severe mental agony and unnecessary trauma.

I demand:

A line-by-line justification for the disallowed amount of Rs. 1, 44, 292.

Compensation for the 22-hour delay and mental harassment.

Accountability for violating IRDAI’s 3-hour settlement mandate.

Patient Details:

Claim No:[protected]

Hospital: Calwin Hospitals

Employee ID: 1203838 (TCS)