Dear Sir/Madam,
This complaint is regarding my reimbursement claim filed with ‘MediAssist TPA Pvt. Limited’ (TPA for Oriental Insurance Company Limited) for Rs. 13, 790 which is withheld unethically by the TPA even after approval without citing any valid reason.
I had a Mediclaim Insurance Policy bearing policy number 272500/48/2018/4611 issued as a policy for PNB Customer covering my family of 3 including my son Nehit Sukhija (aged 2 years now). This policy was in continuation since November 2013 and without any claim.
My son was hospitalised on 24/09/2018 in a non paneled hospital for which I intimated about this admission on 25/09/2017 with intimation id 10671831. All the bills, reports, prescriptions and discharge summery alongwith reimbursement forms and NEFT information was sent to the TPA after getting the form signed by the hospital. Amount claimed being Rs. 13, 790 The claim ID issued by the TPA was 18127868.
After receiving and processing the claim as approved for total amount 13, 790 MediAssist asked me to submit the cancelled cheque mentioning it as missing whereas it was already submitted. I received the message for the same on 23 Oct. On 24 Oct, I replied them about the cheque through mail mentioning that they had received my cancelled cheque and even that is uploaded by them in their app as documents received for claim. I even attached the soft copy of cancelled cheque again in this mail. I was issued a ticked no. 4985216 for this mail. I got no reply for this mail.
After few days I again received a reminder for missing document and was asked to submit it by 8 November. I now sent a new cancelled cheque again through courier (waybill no. [protected]) which was received by them on 6th November 2018 as per records of courier company.
I received no communication from the TPA in this regards. On 8th November my claim was put on hold and I was sent a msg by TPA that it is being reviewed and an update will be received soon.
After waiting for some more days as there was no communication I started to contact at their helpline, which is quite pathetic. After trying it for several days it got connected on 26/11/18 to the executive named Mansur, who was unable to provide any reason for this delay in processing. After forcing him to register my complaint he noted it down and unwillingly provided me with a complaint no. 5670950 and replied that I’ll get the resolution of this case by a week’s time.
Today on 4th December 2018, even after a week I have received no communication in this regard.
One more information, which may be the possible reason of this unethical business practice or behavior shown by the TPA or Insurance company, I would like to tell you and won’t be informed by the TPA that seeing this kind of service I discontinued with the insurance company and got my policy ported to another Insurer wef. 07/11/2018. So, as now I am not their customer now, they have held my payment and no communication is being replied even.
The policy was in force and was duly paid for last 6 years without any claim. After submission of documents, the claim was approved. First they intimated a cheque as missing without realizing that is even uploaded by them as received. Then when it was sent to them twice, no acknowledgement was given.
A real example of Pathetic service being in the service industry which is related to Emergency situations sometimes. Even their executive accepted that their phone lines are poor to connect or handle the queries.
You are requested to kindly look into the matter and help me in realizing this claim from TPA or Insurance Company which is withheld by them without any legal reason.
Thanks and regards.
Amit Sukhija.
#[protected]
[protected]@rediffmail.com
Medi Assist India customer support has been notified about the posted complaint.
Policy no[protected]
Oriental insurance
Total claim 205382
Amount transfer my bank account 176051
Dedution total
Ot charge 22850
medicines drugs 5981
Total deduction 28831
Pl refund My dedication my account and Anwar within 7days.
Otherwise i am complain consumer Coromandel and irda
My claim is pending from around 3 months with Mediassist and I am still waiting to settle my amount. Could you please check with them and settle my amount. Please let me know if you required more information from my end.
Thanks,
Himanshu Garg