Medi Assist India Complaints & Reviews

Sub : short claim amount sanctioned

Sir,

Mediassist id : [protected]
Policy no : [protected]p[protected] o[censored]nited india insurance
Reimbursement claim ref no : 21061898

Kindly refer your letter dated 15/01/2020 regarding my above mentioned claim in which you have sanctioned rs 89973/- only against claimed amount of rs 207023/- towards medical expenses incurred by me for treatment of haemorrhoids at saifee hospital - mumbai.

My observations towards the non - sanctioned amounts is as below :

- rs 20370/- which was charged by saifee hospital for the stapler gun (One time usable) for implanting the staplers. Whereas you are still treating it in miscellaneous income inspite of me submitting the freshly amended original invoice of saifee hospital on 09/01/2020 (As demanded by you).
This invoice clearly mention that this amount was charged for one time usable stapler gun. Hence, i see no reason for not sanctioning of this amount as this was the primary process in the said surgery.

- rs 23000/- was paid by me for pet ct scan at jhankaria imaging. I may mention here that as there is an existence of a big cyst in my pelvic region.in order to clear any doubts regarding any possible infection or cancer, doctor had advised to get this done before surgery so that he is assured to avoid any complication such as spreading of infection or cancer during or after the process of surgery. This should be reimbursed as it was an inseparable part of the process as it might have proved fatal. We may bring in your notice that after this test done and on the basis of its report, dr anup ramani (Senior onco uro surgeon) had given green signal and go ahead for the surgery (Remarks on his prescription can be referred which was provided at the time of filing the claim with other documents). Hence i request to reimburse as the testing was inevitable.

- i may mention here that i have taken lowest category room in single occupancy available in the hospital as per the tariff chart attached earlier. Rs 60366/- was less paid for policy excess / deductible is not not justified and puts burden on me inspite of paying regular premium for so many years.

- i observe that you have not sanctioned many petty charges by the hospital towards bandage, gauge, ecg, dressings, gluco test etc. I may mention here that these are a part of the hospital stay and the surgery. I feel these should be sanctioned.

Sir, i request your goodself to give a sympathetic approach to my above concerns and help me out by reimbursing the said balance non sanctioned amount. Hope you will use your good offices and help me on this matter.

Kindly help


With warm regards,

Anoop kumar gupta
Mobile : [protected]
Email : [protected]@hotmail.com

Bloody #...100 times they keep on asking same documents... And no matter how many times you call they read out the same ready made statements everytime... White collared robbers.

Do you think hospital is there to give you customised document as per your needs.

All uneducated people are hired as support executive who even donot know how to handle the customers call.

My claim was incorrectly processed as the consultation charges of rs3200 are not approved on the grounds that i have not submitted the prescription however strangely medicines bill have been approved for those prescriptions only, all the information is already there then i don't see a valid reason to not process my claim
For this i have contacted your delhi brance twice. On my first visit, the executive sitting on the entry gave his number and asked me to call next day and assured me that this will be done as it is valid claim on my part but when i called and i called for over a week and all calls went unanswered
So i decided to visit again and asked for senior representation, a lady came from inside claiming to be a senior gave me her mail id mona. [protected]@mediassist.in and asked me to drop an email to him next day and she will get it processed as this has been incorrectly processed by them
Now when its been almost 10 days and 3 reminders on emails they are still unanswered.

I don't understand why a customer should suffer for your mistakes and visit again and again. This is clear case of misconduct and on a very serious note this is something which is testing my patience now

I am expecting a early closure to this
Mediassist id:[protected]
Ccn# 21021249
Docs available under attachment: del00435406_bill

I am Thejashree, an employee of HPE company. I have submitted the parental policy accidentally and I wanted the policy to be cancelled since my parents already have lifetime health insurance and tried cancelling wherein it never included that option at all.

Firstly when we have the option to add so we should also have it to cancel as well.Secondly in the parental policy document it is nowhere mentioned that the policy cannot...

I have been following up with mediassist from 6 months regarding the claim reimbursement of health insurance of my parents and the response is becoming worse day by day. They don't even care and every time they say that it will take 7 to 10 working days and its been 6 months. They are not even trying to resolve the issue despite multiple attempts by me. There is no reason being given and they say that the back-end team will resolve the issue from past 6 months. I have raised the claim from 31st august, 2019. I has become tiresome to call every day and get same response and no lead towards my issue.

I submitted a cataract eye surgery claim for rs 34, 895 on 06/09/2019. After 4 month battle with them, they denied my claim on 25/01/2020. I have not been notified formally with the reason yet.

During claim review, i was kept on getting different questions as soon as addressing previous queries. When i asked for more information from customer care, each one telling different reasons. I don't have a direct way to contact claims department. I'm not sure why they are looking for original documents. Even after submitting originals, they are saying they did not receive them and asking to resend the same. How can i send original document, when i sent the one already? These fellows not even agreeing duplicate copies.

After spending days & hours of talking to cust. Care and writing pages of emails, i earned only frustration. Pls, pls, pls do not go for this service provider.

I have experience in submitting claims with us and canada med. Ins. Service providers. I never seen such a worst service there, where no need to submit originals as well. I'm very much worried about other customers' situation who submit expensive claims.

- every time we call customer care, we are getting different answers.
- we don't have any means (Email/phone/text) to convey our response to claims department directly.
- customer care has no rights on our claims
- customer care says, "we will take care of your concerns and queries". But no fortune happens at the end.
- poor website and navigation system, not user friendly. They have option to enter comment on our claim, but we cannot. This is really frustrating.
- we have to pay premium for this useless service.
- not worth a penny.

Our hospital claim bill no 2724 dt 14.12.2016 - rs. 186898/-
Pt name :ivakumar doa 08.12.2016 dod 14.12.2016 —
Approved under 2 claim nos - base policy and top up policy
Claim no[protected] appd rs. 67500/- under base poliocy
Cliam no[protected] appd rs. 88920/- under top up policy

While rs 88920/- settled way back on 10.04.2017 the amt of rs 67500/- pending for more than 3 years???

Taking legal action if settlement not recd by 10th feb 2020//ok

This is with reference to the cashless claim[protected] & policy no.[protected] submitted with the details: for surgery of
Provisional diagnosis unilateral inguinal hernia, with obstruction. Hospital requested rs.63000 for total expenses but you have approved on rs.29750. Hence hospital has refuse the surgery. Please let me know why you are keeping such type hospital in your ppn list who is unable to do the services in agreed tariff. What is the mistake of patient. If anythings happened to my patient you are only responsible.

This is with reference to the cashless claim[protected] & policy no.[protected] submitted with the details: for surgery of
Provisional diagnosis unilateral inguinal hernia, with obstruction. Hospital requested rs.63000 for total expenses but you have approved on rs.29750. Hence hospital has refuse the surgery. Please let me know why you are keeping such type hospital in your ppn list who is unable to do the services in agreed tariff. What is the mistake of patient.

I am employee at mnc company and document submitted for my wife name which has mninimum 30 day period to do addition. But medi assist team had not process the document and now it is almost 3 month i am just runing behind to add the name so i can avail cashless benefit for my wife, whome cancer treatment is on progress. Serveral email & call are made but no action or effort to do the work is seen

Yesterday i feel a upset mind of their deals. We can't raise any question about the price and such as. They argued with us that they doing sacrification for the people, that is low prices of medicine.

Dear concern,

Sub:arrogant behaviour if janauahadhi njarakal ernakulam 682505

My name is joseph desouza approached to buy a reapeat medicine which i found a hike of 12 rs from previous bill, as a concern asked the reason for the hike which i rcvd a very harsh response from the lady staff who was tgere in[protected]. She was shouting at me in front of other customers saying dont give the mediceine to me.. Give once the real government medicine available... Request you to ensure the staff behaves properly to the poor patients when and then they approcah your concern..

Regards
Joy dsouza

Hi Sir/Mam,

I am Kaushik Chakraborty son of Late Biplab Chakraborty. (Retired Bank of Boroda Employee, BOB EMP ID#34372)
Clam No. # 20869914, Medi Assist ID#[protected]

I had submitted a hospital admission claim with all the required document on 5th Nov 2019 and after that query was raised by the team. I had submitted the missing documents again and received the Claim Document Receipt acknowledge email on 4th of Dec 2019 with the Tracking # KOL00180899, after that I have received no more update and neither the amount was credited.

I have called the insurance customer care Toll Free no# [protected] and they informed me that the claim is still pending and under investigation since 4th Dec 2019.

My father passed away on Oct 2019 and after doing all the formality for submitting the insurance claim and paying the insurance premiums on time still there is a long delay and no proper update from the insurance team.

Initially, it was told to us from the insurance team that within 15 days of submitting the details we will get the amount, now it is almost 3 months but still we have not received the amount.

Requesting you to please do the needful.

Thanks,
Kaushik Chakraborty
Son of Biplab Chakraborty
Contact No. - [protected]

My claim number after going through all the stupidity that i faced talking to all the agents someone finally maybe a supervisor i am not sure called up and explained me that the documents needed are the once which has detail break for receipt no 1076 and receipt no 3007 which i have dropped in claim drop box at wipro location on 6th january 2020 and the reference number/ tracking number for the same is blr00863800. The claim was under adjudication and now returned with an sms asking for missing documents which when checked on the application is kindly enclose the details for bills 1076 and 3007.

These guys are fraud. They will ask you to submit all the original documents and then once you submit the documents they will again ask you to submit the original documents which of course you wont have as you have already submitted them.

Get this resolved asap and pay for the claim.

I have submitted original docs as maternity claim, one for myelf and another for ma baby to employess of mediassist.in nov end i came to know that person is removed by mediassist as he was not answering any mode of communication. So i have taken this matter with tripti salian and assured me that she will take care and not to worry.in jan she is replying your claim will b process but baby file we are not getting, i asked how it is possible! She said she will find out and let me know the status of it. Still then m waiting for her reply as well as my claim is also not received. Now i don't have their any no. Online no. I am trying it is not working. I told them clearly that m on maternity leave and came to dubai so for me contacting is expensive as well as difficult. Still they don't bothered at all. I will never recommend to go for this mediassist to anyone after this experience and if i came to know that anyone is going, i will try my best for not to opt insurance from mediassist. It is simply harrasment!

I have raised claim, submitted 13 original papers. They put claim on hold without proper requirement. No transparency, no one is ready to talk with me to discuss the claim no response over mail. Worst company, no one is ready to take care of my claim ticket number [protected]. Please put some regulations. I was ignored in the tech support call. After 1 hour wait period the call simple closed without answer.

Please note that i have put a claim fro my son and the claim no is 21210238
. My claim is rejected in query which was not asked to me but my wife. Where as she don't know anything about this claim and query. Also the query person arrived without prior knowledge and information at home and started directly query in my absence as the claim is related to me not my wife. This claim rejected and the reason is not given to me through mail my any source. When i enquire then i came to know that my claim was rejected in query which was not even in my knowledge. Latter i came to know that they came at my home and asked several question to my wife regarding the admission and rejected the claim. Please let me know the valid legal reason for rejection of claim and why query was not done in front of me.

Hi team,
My medi assist claim no:99780950
Insurance company: united india insurance

Up on requested for the following set of original documents:
1. Self declaration letter
2. Intoxication letter
3. Pre & post surgery x-ray films
4. Implant sticker details.

I have sent all those documents via my employer (Wipro) drop box on 17 dec 2019 with tracking id: blr00844021. Got the acknowledgment for the same from the medi assist india tpa. After the receipt of the documents the tpa has denied my claim stating the insured haven’t provided the above documents. Up on contacted there is no proper response and same set of documents is asked again and again. As i have submitted the originals already how i supposed resubmit them. Kindly resolve the dispute at the earliest.

Sub : claim no. 20298857
Policy no.[protected]
Insurer claim no. Tp[protected]
Insurer member id po 27915647

My husband mr. Shekhar deshmukh was admitted in nanavati hospital for fever, cough, cold, chest and left lower back pain on 4th august 2019. The doctor diagnosed the fever as h1n1 and lower respiratory tract infection. After hospitalization the fever had gone but respiratory problem was still there. Dr. Also suggested angiography which we have done after clearing the cough /cold infection.

We have submitted required documents regarding insurance claim of mr. Shekhar s. Deshmukh in stipulated time i. E. On 19th august 2019. We have also submitted internal case papers on 26th august 2019 as demanded by the company. We have also done angiography as suggested by our doctor but not submitted the angiography documents and claim papers, as doctor has given discharge on the same day i. E. On 27th august only.

The claim has been denied by giving remark ‘no need of hospitalization’ on 25th october 2019 with no valid reason. After that, we have submitted the supporting documents explaining the need of hospitalization on 13th november 2019.in december 2019 my agent mrs. Janhavi sathe visited the office to remind them regarding claim. But no response from the insurance company received by us.

It is really surprise, the way your organization giving service to genuine insurer. It look like we have wasted our money by paying premium regularly. Though, our claim amount is much less than premium paid.

Now, request you to look in to matter & advise on settling the claim on top priority as it has alomost more than 4 (Four) months have passed after submitting justification letter from our doctor.

We hereby also request you to our angiography reimbursement with the said claim.

Thanks and regards,
Madhuri
(Wife of mr. Deshmukh)

My medical reimbursement for two claims has been pending for settlement since the past 45 days.
Claim nos. 20950611 and 21078289
Original papers, documents and reports are being submitted. Till today it has not been settled and as a result i am unable to proceed for further treatment. Is the insurance team waiting for the patient to die??
This is the worst insurance company i ve come across. If it had not been the tied up insurance for my organisation, i would never had insured in this company.

Not recommended for any individual.

If rating can be done in public, would have rated -0/10.

I’m really frustrated to keep on calling Medi Assist for each and every time I’m getting the same response “We will escalate to concern team and will get back to 2-3 days”. Who’s that concern team? Is not MediAssit or any other vendor.

Today, again I called (3rd time) and explained the complete story and waiting for some good response. But again the same template “We will escalate to concern team and will get back to 2-3 days”.

I asked if I didn’t get any response, what’s my next step. She said please send an email to Medi Assist and definitely I’m sure I will not get any response except the same template “Thanks for writing….” There is no point of contact for escalations.

My very straight forward questions below:-
What’s the turnaround timeline for my request?
When this will get resolved (timeline)?
When should I call back again? And what’s my next step if there is no proper response?
Who’s the escalation POC?