Medi Assist India Complaints & Reviews

Sir kindly go through the below complaint which i have reported to mediassist india however neither they ever replied nor they finally processed the claim correctly.
Pfb the complaints which i addressed to medi assist over the email:-

Dear sir/madam,

As per above mentioned subject i would like to report you the
Harassment that i had to face due to delay processing (Still pending)
Of said claim# 19184296 which is for my mother smt. Leela sharma and
Claimed for congenital heart defect - asd closure.

The details related to said claim is under:-

1. I have applied for planned hospitalisation on 15/03/2019 and
Hospital at their level sent initial request on same day 15:37 pm and
Also provided estimate with their tariff schedule and break up of that
For rs. 2, 70, 000.00

2. Initial request was finally processed on 14/03/2019 for rs.70, 000/-
Against rs. 2, 70, 000/-

3. On 15/03/2019 i admitted my mother to hospital and all remained
Good and we are discharged from hospital on 18/03/2019 and hospital
Has sent discharge summary and final bill to mediassist on 15:32 pm on
Time they did not make delay at their level.

4. From 15:32 pm to 20:53 pm there was no query (During 5 hrs 21
Minutes) from processing team of mediclaim department/person, (Since
Same i was tracking on medi buddy application, and i suppose it
Provides correct information).

5. I called even toll free no.[protected] till 8.15 pm and they keep
Saying that there is no query till that time and also told me that it
Will be processed within 20-30 mins.

6. When it was not processed then finally i have to call mr. Jaimin
(Medi assist representative sitting at my hrm) on 08:23 or 08: 24 pm
And he told me that there is unreplied query on this claim means query
Has already raised and not replied (As per his words) however before
08:50 pm or 08:53 pm i was not able to see any query at medi buddy
Application. Nor hospital received any email till that time regarding
Any query till that time.

After 08:52 or 08:53 pm when i was sitting before hospital
Representative then only a mail came to mediclaim department stating
Some query.

Now,
I request mediassist team, please make me aware of -

What is your tat (Turn around time) or duration of checking claim
For raising first query, if required or completing the process of
Claim as final approval???

When you have raised the first query on this claim and if it was
Raised after 4 hrs (Since every representative on toll free no. Is
Giving me tat as 4 hrs) then kindly explain me the
Reason of delay??

How you deal or get the claim processing done at late night hrs when
There will not be any representative of mediclaim department
(Designated) as due to your late reporting of query this situation has
To face that none of representative (Designated/specialized) was
Available at 09:00 pm and due to that claim processing has remained
Unprocessed and who is responsible in this case when you raised the
Query almost after 5 hrs 21 minutes (As per medi buddy application
Interface) since even after discharge i could not take my mother from
Hospital??

I would say this is as harassment because this is second time due to
Not timely processing i have waste one more day in the hospital to get
The claim process completed and take my mother back to home from
Hospital and also its a prestige issue being an employee of such
Reputed bank that we are in the hospital even after discharge because
We availed cashless facility (Or in this case i must report it as
Difficulty rather than facility) and we are even asked to deposit
Money and go home and since it was too late to arrange money at night,
It made as feel humiliated just because of your processing delay of
Cashless claim.

I called (Almost 9.30 pm) and raised issue before mr. Jaimin and also
Make him aware that due to delay processing of this claim my mother
Has to stay at hospital and one more attendant has to stay at hospital
Even after discharge and it is possible, hospital is going to take
Room charges or other charges for extra stay, i got a surprised answer
From him that whatever charge is hospital going to take claim them as
Post hospitalization charges,
Kindly make me understand why i should claim those
Charges as post hospitalization charges while neither it was advised
By any authorised person (Doctor etc) and why i should bear this
Charges out of my available limit of mediclaim???
And how these charges going to be justified before you to reimburse???

When i called on toll free no.[protected] at 10.33 pm that time call
Ref# 4308026 the representative was saying me this is specific claim
By quoting "congenital disease" means he clearly indicated that
Intentionally my claim (I even recorded every calls) is being hold and
Intentionally we are being bothered, why??? As per our corporate
Communication which came in 2015 in which its clearly stated
Congenital disease are covered also cost of implants are other
Medicines examinations (Lab reports) etc are covered that has came in
Picture in 2015, now what has become specific in this??? While
Pre-authorisation has already been processed then how can you claim
This claim as specific and not processing this in 4 hrs tat??? Are you
Considering in this case other than what is communicated as per "iba
Medical insurance scheme""??? Are you considering my policy out of
Scope of iba medical insurance scheme???

If its so then immediately let me know as i will report it to my
Reputed organization and if possible, i will request my corporate to
Cover me with other available option as per our internal
Communication so that we can enjoy industry level medical insurance
Scheme that is called iba medical insurance scheme.

In the last cashless claim# 19184296 just because of your processing
Error i has to face pain while settlement claim and faced trouble
(However) and even i had to take leave from office (Which was
Purposeless) and have to waste my time again due to your delay
Response (If you would have raised the query on claim # 19184296, on
Time) again i have to take leave for tomorrow just because of your
Working style, to settle hospital claim and to get the things done.

You have wasted my two days and medi assist is only responsible for
This since its march ending and we need to be more active.

Also i would like to know when last updated tariff plan was shared by
Hospital to you (Since i can see your last query is based on that) so
That i can understand the details of package that i opted was already
Available with you or not???

I request you to come with a reasonable response on my queries so that
I can analyse whether its a facility for us or difficulty??

Thanks and regards,

Sachin sharma
Primary policy holder
Canara bank raopura

I filed the insurance claim for my father in medi assist at nov 2018 but still the case has not been resolved they are stating that the medical bills are undue but when i ask how come it is possible? I already given all aunthentic medical bills so on which behalf you are declaring that bills are left
To be paid? While asking them on helpline number they hang up the call after letting me wait 20-30 min and no one call back on my registered mobile number.

Please kindly do the needful and take some action against on it.

Policy holder name. Mr. Adeshkumar gupta
Claim no: 18466055

I have got the National insurance parivar medical insurance policy[protected] which is 5 years old and covers the infertility treatment upto 50000. last month i had submitted the reimbursement form to Mediassit to settle the claim amount and sent all the required medical bills and documents. unfortunately my claim got denied with improper justification.
when i called up customer care one of the representative updated stating claim was denied because my policy is not eligible for claim as it does not satisfy the minimum number of years(3) old, i checked my records and sent the relevant proof that my policy is 5 year old to them through mail and i got different reason for claim denial. I would like to escalate this issue to higher authority as i am not satisfied with the justification and i feel like cheated

Hi,

This is ravi from pune.

I registered the claim in medi assist 3 months ago, claim come into process on 26th dec 2018. Even after confirmation of reception of claim document by medi assist, they are again asking for some irreverent documents four different times explicitly. Even then i submitted on 5th of march. After that there was a confirmation mail that they are going to update on it on next working day. It is already two weeks but none has reverted to my mail nor amount is not credited to my account.

I taken many follow up but no one responding me in a responsible way. My medical bill is rs 5847/-.

Please do some needful, take a strong action and solve it asap.

Policy holder name. Ms. Ravi shankar kumar
Emp no: 32
Claim no: 18608453

Hi team,

i had put a claim for my treatment from wipro (Claim #:[protected], which was denied due to delay in claim submission.

the claim requested is not for a regular hospitalization but for a treatment which is unusual. I hope you understand this treatment in particular links to a lot of personal emotions, and increases multi-folds when the results are not as expected.

It was a personal setback for me and my family. I went through a lot of personal trauma and personally was not in a state of mind to think about anything beyond this personal loss.

It took me some time to gather my thoughts together and come to terms and accept the facts. It is only after this that i realized and could think about the financial aspect and the time lost to claim the amount.

I do realize there has been a delay from my end to request for the claim. But request you to take into consideration my past track record – there has never been a delay like this earlier, and the sensitivity of what i have undergone and put an exception for my case.

This claim will possibly give me a hope and financial support to look at the opportunity for a second attempt at this. Though physically it will be very taxing for me, but at least i would be rest assured that financially i am a bit secured.

I am really hoping for an exception here. Requesting and looking forward for an assertive response.

thank you.
Prachi mane
[protected]

Medicity kharghar is a network hospital for mediassist. During my cashless hospitalization, the hospital made me pay bills by cash. As per policy, cashless should be without any payment.
The bills paid are supposed to be reimbursed by me by following up with mediassist post hospitalization.

The hospital has not explained why cashless facility was not provided to me

Hi team,

Please note that i had provided all the bills as post hospitalization expenses, medi team not approved consultation charges as it was part of post hospitalization bills. I do not understand one thing when i had already provided consultation bills from the doctor and requesting them to approve the consultation charges, they said consultation paper required, but my doctor was said in india we do not follow the consultation paper pattern it will be only consultation bills. My baby was pre matured hence i had to visit the doctor frequently as my baby was in icu for a week.

I would need your help to get the amount reimbursed the same

Claim#18717421.

Appreciate your help.

Regards,
Sheela s

My claim number is 19024972. I submitted the documents in february 1st week. Received a acknowledgement that they received the documents and by march 1st, they confirmed that claim has been approved and payment will be processed in 5 business days.. But, i'm yet to receive the payment and still waiting for update. No proper customer service or helping team. Kindly help with getting the money.

I was admitted in september 2018, with claim number 18085689. My claim is still not reimbursed. I have not been informed by any means as to why there is so much delay.
I wish to know the status and reason for delay. If denied then what is the reason for denial.
I am tired of calling multiple times to oriental company and to mediassist but no answer is provided by them.
Pathetic services.

My claim id no is 18757981 and maid id is [protected]. Reimbursement claim of amount 43022 due to documents not submitted on time as per your mail you send a reminder three time to send a required documents but i not submitted it on time, but after requirement updated on your site i uploaded the required documents on your site and also send a hard copy of the documents to you on 25th feb 2019 but as per your mail my documents received by you on 7th march 2019. Delay of submission is not from my side i send it on time. Kindly reconsider my claim or i am going to registered a complain in consumer forum.

My claim number 97782604 for rs 4500 has been processed with an approved amount of 500 saying the bill does not have pre-printed bill number. When called up their customer care, twice, they asked me to submit a clarification letter from doctor stating that in their facility, they do not have provision for pre-printed bill number.in spite of submitting all these documents they approved amount of 500 for a claim of 4500. When contacting through mail, describing the entire incident, they only revert again with no pre-printed bill number in bill. They do not reply anything concerning the clarification letter. If they do not accept clarification letter why are their customer care misguiding people with incorrect information? I want an immediate resolution to this as i am behind this issue for last 2 months.

My user id [protected]@sbi. When i logged in i found that my gender is mentioned as 'others' instead of 'male'. I understand the person who does the data entry does not know alphabets in english. Please change this and confirm to me. I did not receive my ecards also. Please check and send the ecards to my email [protected]@gmail.Com. I also suggest you not engage such a useless staff.

D vijayudu
dy manager (rtd)
state bank of india
pf no 2763842

Sir,

This is in regards to above subject matter details ; i bharatbhai v savalia, age : 63 years am having national insurance policy no :[protected]. I have undergone a cancer surgery for which all documents have been submitted along with required reports and bills on 23rd nov 2018 for claim. The amount of claim was rs. 3, 07, 545/- (Three lacs seven thousand five hundred and forty five only), while the approved amount as per 12th february intimation through sms was rs. 1, 50.183/- (One lac fifty thousand one hundred and eighty three).

On 13th february my visit to your office and had a discussion with representative, he asked to submit hospital declaration on gst. However as per clause no 82, the hospital is not legally required to obtain gst no and hence attaching the declaration on the same by hospital.

Request you to please let me know the reason on deduction of following amount to me as soon as possible.

Description

Bill amount

Payable

Non payable / reason

Other miscellaneous charges

200

—

200

Ot charges

38000

21250

16750

Surgeon charges

124997

84997

40000

Anaesthaesthist charges

30000

25000

5000

Consultation / visit

25000

—

25000

Medicines/drugs

53725

—

53725

Deduction details:

Description

Deduction amount

Remarks

Copay

—

—

Hospital discount

16687

—

We have paid hospital bills by taking some financial support from relatives with a polite commitment of returning in 15- 20 days. Now my situation is worst to explain it in writing to you.

I am a senior citizen who is not having enough energy to follow every time as the medi assist and national insurance are actually passing the bucks.

Please understand sir, now i go to the medi assist office by spending 110 rs which is further disturbing my financial condition.

Dear sir, with reference to above subject i kanaksingh parmar holds a group mediclaim policy through my corporate pnb metlife insurance company ltd. My individual policy no is 222900/28/18/p1/02650932 & my parental policy number is 222900/28/18/p1/02652775. I have raised a reimbursement claim for the amount of 74828/- on 16th jan 2019 through tpa mediassist claim number is 18792814. My claims all investigation & all procedure was completed successfully by your tpa on 7th february 2019 and i have informed the investigation officer how the hospitalization incident occured and was verified by investigation officer. My mother has wrongly/unintentionally taken a poisonous medicine which was used for my pet's cure inspite of her regular syrup which she takes regularly for her cough/congestion. It was misunderstood by the shreeji hospital & mlc was filled which unknowingly signed by my father mangalsingh parmaras he was completely disturbed at the time of hospitalization as he was busy with my mother khemalben parmar treatment. At the time of treatment which was going on at hopsital even police officers also visited hopsital as mlc was filled and police also recorded the statement of my mother & also asked the relatives about the incident happening. After the completing primary treatment we shifted my mother to bhailal amin general hospital where further treatment was carried on bhailal amin hospital also carried on the treatment on the basis of documents received from shreeji hospitals. I request you to kindly consider the case & proceed further asap.

Hi,

I am raghavendra pise ex-employee of wipro limited.

Last year during october month, i have raised below two claims for united india insurance through mediassist.

Policy numbers :[protected]

The claim was approved on nov 2018 and sent for credit note but amount is not yet credited to my account.

I have been doing a follow up with mediassist customer care but they giving other reason.

Medi assist customer care saying due to change in payment process its delaying. This reason doesn't seems to correct because last 4 months they are same reason which is not believable.

Could you please help here to resolve this issue.

With reference to above mentioned claim no you have written account no [protected] where as the account no given to you is [protected]
kindly send the amount at the proper account no. my claim no 18232924 is already settled as you have sent the amount in punjab national bank it went back to you as i inquired from the bank, my Employ id is PNB-ORI-ROY-[protected] AND MY MEDI ASSIST ID IS [protected], INSURER CLAIM NO IS 272900/48/2019/005528.You have deposited rs 261993 vide claim no 18232924
regards dr vijay khariwal

Hi mediassist,
Regarding claim no 1871825, for new born baby claims, submitted the documents on 20november and today is 15feb still the status remain amount approved with insurer. I do not know of every thing is approved why the dispatching of amount taking so much time. I have mail proof also that wrong information has been shared that transaction has been done. That's very annoying that u guys are just dragging without any reasons. Kindly settle the claim.

My claim no 97626815 of maid no [protected] name sudha babu of claim amount 40708 was not fully approved and the reason for non approval was hertraz.in my past and later claims the bills containing the same medicine was passed. Then why rejection in this claim. It's the same medicine used for cancer and it's the same medicine used before and after this claim. Only claim no 97626815 gets rejected.

Mediassist has played fraud. by denying 22 thousand rupees.
The claim was submitted on 30th jan 2019, which is well within the date.
The claim was submitted for my new born baby with expenses of Rs 23849

Mediclaim automatically created a new record of its own with my spouse name on 8th Feb(which is outside the date)
attached are the screenshots

CCN# 18948238 under policy# 900001/12001/2017/A[protected]

Patient Name Swati Chandra
Policy Holder IBM India Pvt Ltd - Emp
Primary Beneficiary Praveen Raja
Medi Assist ID [protected]
Policy No. 900001/12001/2017/A[protected]
Relationship with Primary Beneficiary Spouse
Employee ID 04528N
Procedure / Treatment Planned Medical management
Insurer Claim No
Insurer Member ID [protected]

Summary of Approval

Processed Amount (INR) 1152

I have submitted the above claim for my treatment of diabetics, htn, dislipidemia, thyroidism, uric acid and frozen shoulder due to my accident and operation in right hand. I had submitted all bills vide above claim no. 18191648 on 24/09/2018 which was acknowledged by you on 29/09/2018. An information was sought on 20/10/2018 for submission of physiotherapy advise from orthopaedician and date wise physio therapy chart. On 7th dec'18 information awaited advice generated and on 8th dec'18 the subject claim was closed at your end.in this connection, i would like to say that i have already submitted all the bills/vouchers etc from the treating doctor and physio therapist but for the want of date wise physio chart, my claim was not sanctioned and the same was closed. I have taken up the matter with your office located in our canara bank office, ranchi for the sanction of the same several times but no solution was given and my genuine claim was denied. Kindly let me know whether physio therapist is a valid doctor or not? If your office did not want to approve the physio therapy bill, then why the bills of my medicines and doctor's fee was also not sanctioned? I feel that you have not ensured due diligence and your positive attitude towards my case. I request you to kindly consider my request and reopen the claim and sanction the same at the earliest please. An early action in this regard will be highly appreciated.
With regards,
Manikant sharma
Staff no.67699
Canara bank
Telco colony
Jamshedpur
Mbl [protected]