Medi Assist India Complaints & Reviews

Name of the Complainant: Durga Sankar Joardar
Reference Claim No.17670883
Claim Acknowledgement Letter No. 4469103
Date of Submission of Claim Form duly filled: August 17, 2018
Date of Receipt of Claim Acknowledgement Letter by Complainant: August 29, 2018.

Additional Document required by this letter no. 4469103 dated August 29, 2018 as follows:

A). All past history, duration and treatment sheet related to this hospitalization.
B). Doctor Advice for admission to hospital.

The above mentioned documents were submitted in your Kolkata office on September 15, 2018. The history sheet from the hospital mentioning the duration of T2DM and HTN duly authorized by the Physician were submitted. All the treatment sheets were already submitted on August 17, 2018.

I received the following e-mail 8 times from you office up to October 01, 2018 as follows:

Kindly provide duration of T2DM, HTN, PROSTATOMEGALY from the treating doctor

But the same was already submitted to your office on September 15, 2018. It is clearly implies that your office staff did not understand hospital documents duly authorized by the Physician.
Then I sent an e-mail on September 27, 2018 as follows:

Quote:

Dear Sirs:

This refers to mail dated September 27, 2018.

The required documents duly authorized by the Physician were submitted at Kolkata office on September 15, 2018. The stamped receipt is available with me.
I cannot understand why you are asking the said document which was already submitted to your office.

I would request you to go through the 'History Sheet' of the hospital and you will find the same. As per this sheet:

A. Duration of HTN: For last six months
B. Duration of T2DM: For last seven months.
The diagnosis of Prostatomegaly was first time done after the admission in the hospital. That is the reason there is no past history.

I do hope that you are now satisfied related to your enquary.

Please do the needful at the earliest.

Regards,

Durga Sankar Joardar

Unquote:

After this mail, the request for missing documents from your office has been stopped.

Today is October 10, 2018. Still my claim settlement has not been completed.

In view of this situation, I would request you doing the needful at the earliest.
I am a senior citizen of 71 years old having no other income like pension.

Regards,

Durga sankar Joardar
E mail ID: [protected]@gmail.com
Contact No. (+91) [protected]

My claim was approved on 24th of aug and was told that the payment will be made within 10 days but its been 1.5 months and i have not received the amount. I have reached out to mediassist customer care multiple times but it is still pending. Can you please look into it and update me on this?
Claim number 17693017

Regards,
Abhishek kumar jha
[protected]

Claim ID[protected] Reimbursement claim still pending for approval since 1 month. Customer Care not responding properly and even the coordinating branch Indore is unable to give proper response or solution. Submitted all Documents in best possible manner spending almost 300 rs in courier for query redressal daak/correspondence so faar. Money spent in cash by Son for father who was hospitalized, all bills, clarification is submitted. Document coordinating branch is Indore Madhya pradesh, sent to Mr Bhoopendra Chaturvedi. Verbal Queries are being generated every now and then and not in writing or in the status portal. Every time new UNREALISTIC /NON PRACTICALLY VIABLE query is raised that too verbally. I think the Team is unable to understand what exact is the requirement. Earlier also due to this misunderstanding they initially approved but then rejected after 20 days for the same claim, and when i re submitted the documents from Testing center regarding clarity on charges, claim we are admitted but stand unaddressed yet. Current Status is 'Information Awaited' now its 1 month. We would be forced to approach to Insurance Ombudsman in case still unresolved.

Hello sir

I have oriental medi claim insurance policy since march 2015. I was admitted to fortis noida on 30th sep 2018 and discharged on 3rd oct 2018. Medi assist rejected my claim with out any satisfactory reason. This was the first time in my life i was admitted to a hospital for any issue.
I have been paying premium from last four years for nothing.

Claim number 17924794
This is a partial claim. We have provided signed claim form, attested hard copies of other tpa, original receipt of excess amount paid. Yet claim is put on hold for second time asking me to provide itemwise breakup. This was provided on 29th sep, yet again claim put on hold, again asking to provide itemwise breakup and hard copies. All this is provided. I called call centre and it was hell. I was harrased to a point where i felt it's better to die than ask for claim
Tkt # 4830957 gives all details of my experience with call centre.
Tkt # 433979 gives details of how irresponsible execs and claim team is.
Btw none of my tkts are attended and still open.
I have lost hope and almost in depression as i will be loosing my hard earned money.
Hope there is one soul listening.

Hi Kavtha,

As per my discussion with Mani (Medi-Assist Customer Care Officer) on finding the reason for Claim Rejection, came to know that the issue was because the Doctor & Patient names have got interchanged, because of the mistake by Med-Assist agent.

Please find below the names of Doctor & Patient:

Doctor Name: M.S.Rani
Patient Name: ASWANI

My wife admitted in kothari medical centre on 29.04.2018. During admission i don't received the cashless benefit. As per hospital & dealing tpa at kothari medical centre, i deposit the total amount to hospital and with a advice that i have to submit the document for claim to medi assist office. Accordingly, i submitted the claim form with relevant document on 07.05.2018 at medi assist office. After that i have made several phone call, physical meet at medi assist office. But unfortunately nothing happened. Still i have not received any reimbursement from medi assist. If i suffer like this, why i paid the mediclaim policy since 7 years. My insurance company is oriental insurance. Please help me to settle the claim. My claim amount is rs. 44729.00

Cashless claim (Claim #[protected] for meena ganatraatra was submitted on[protected] at 17:22. For insurer claim ref# 144000/48/2018/006520
An amount of 10000 will be paid to sterling ramkrishna speciality hospital and wasapproved. But still the amounts are not paid. All the documents were submitted by hospital. Even we have sent the mail id and tried to contact cistomer care on toll free number they said it will be settled but still...

I had undergone an surgery tah for which pre auth was rs 83 000/=.
However post operation there was additional medical expense of 10998, which is not reimbursed to me. Since last 45 days im writing to the mediassist team for our corporate employee group, but no valid response.
They are mentioning reason for disapproval as excess of gipsa package.
Request break up of gipsa package 9 to verify if hospital has overcharged us)
N also copy of policy to prove that claim / reimbursement is limited to gipsa package.

Around 5-6 mails and follow ups and no valid response from the company

This is Bhanu Prasad S/o Narasinga Rao who is an LIC agent having corporate insurance policy and the TPA is Mediassist. Mr. Narasinga Rao had undergone two surgeries one is TURBT and the other is Radical Cysectomy due to the attack of Bladder Cancer.

We applied for the reimbursement of pre hospitalisation expenses for the above two surgeries and the details are

Mediassis Id: [protected]

1) TURBT...

Sub claim no : 17514157 : requesting for reverification of the medical bills.[protected]

As per my discussion with mani (Medi-assist customer care officer) on finding the reason for claim rejection, came to know that the issue was because the doctor & patient names have got interchanged, because of the mistake by med-assist agent.

Please find below the names of doctor & patient:

Doctor name: m. S. Rani
Patient name: aswani

Pfb details:

Dedicated id : [protected]@infy
Employee id: 645161


Aswani + baby =64000 (Date[protected] to[protected]
Baby =15200 (Date[protected] to[protected]
Total amount = 79200 (Inr)

Total amount is 79200 (Inr).

Can you please update your records as given above and let me know the status on the request as early as possible. It has already been delayed very long and would like to get this resolved at the earliest.

Let me know for any issues.

Could you please help me madam regarding claim.


Regards,
Mahesh,
#[protected]

S highly intolerable that i didn’t get any reply from you for the past 3 days. I need information on the following:

I would like to know about the list of ayurvedic/ siddha hospitals to treat heart related ailments using cashless mode. I have already raised a request on medi assist portal with ticket number 4726664. I need prompt actions as the sla is breached for that ticket. It is an emergency situation and so please consider this as priority. Would like to contact the medi assist representative to discuss on this.

Last two months onwards i have send 20 mails and 30 calls but nobody properly responded.

Please let me know reason.

I have enquired with the medi-assist customer care team for the reason of denying our medical bills related to my wife’s pregnancy expenses along with kid’s medical expenses.
Medi-assist team suggested to get the re-verification done for the expenses claimed once again with srujana hospital as there is some discrepancies.
But, when i checked with srujana hospital management team, they are confirming on the correct submission of the medical expenses to the medi-assist team.
I am really not sure, where and what kind of discrepancies happened, when going through the details given in the portal for denying the claims.

Requesting medi-assist team to once again re-verify the claim documents and highlight for any issues. Please let me know on the status asap.

Please revert me in case of any further details are required in this context.

Pfb details:

Dedicated id : [protected]@infy
Employee id: 645161


Aswani + baby =64000 (Date[protected] to[protected]
Baby =15200 (Date[protected] to[protected]
Total amount = 79200 (Inr)

Total amount is 79200 (Inr).

Kindly recheck once.

My wife name is [censored]al Sharad Parteki. My wife is pregnant please add the name

Dear Sir/Madam,

I have Submitted all documents for the claim settlement to wards Mediassist but they are not going to pass the claim and intentionally demanding new requirement of documents and doing delay for the process.

As per required documents below original hard copy was submitted to words Mediassist.

1.Employee claim from with all details
2. Hospital Information & registration number with all doctor details
3. Discharge card (original)
4. Investigation report (Spouse pregnancy sonograpy with baby scan image, Baby foot print and hospital delivery report with seal and stamp )
5. All blood report
6. All original medicine bills, Main hospital bill break up, Hospital receipt with sign stamp )
7. Adhar Card & pan card
8. Doctor precipitations

All original documents submitted then also demanding investigation report (Is pregnancy sonograpy is not investigation report ?).

After sending same scan copy then agreed for the same but before that hard copy was submitted which means that cratered unwanted delay.

Again next new additional demanding, they asking for submission of original fee receipt that also i was submitted with stamp and hospital seal and same confirmation was taken from Medi Assist representative, he said ok.

Now next feedback received from medi assist, receipt number is required printed instead of hand written which is intentionally making delay and claim is not going to process.

As per regulation & compliance all things are covered in receipt as an amount receiving proof.

Please find the attached documents for your reference.

Kindly lookout for issue & Help for claim settlement.

Please click on below Link for submission of documents towards Medi-Assist.

https://www.dropbox.com/s/1yt0rgbxy71lw46/medi%20claims%20sakshi%20pawar%20form%...⇄

Mediassist Adders Details:

Himanshu Kukreja,
Medi Assist Insurance TPA Pvt. Ltd.8
B, Second Floor, Tej Building,
Bahadur Shah Zafar Marg, ITO,
Near The Times of India Building
Pin Code-110002, New Delhi

Medi-Assist Contact No.
Manjunath TR-[protected]

Insurer Details:
Emp No: 211056
Emp Name : Ashish Pawar
Policy Holder : Jones Lang Lasalle Property Consultans India Pvt Ltd
MAID : [protected]
Insurer Claim No : TP[protected]
Insurer Member Id : MEMBER13154

My police no. 171600/48/2019/8275 PNB ORIENTAL ( MDI ASSIST)
its writen letter me dr. kanu bhai parmar "

this is to certfy that mansukhbhai b vankar pt is admitted under my care from[protected] to[protected] during admiision pt`s one of diagnosis is accolarated HT` .this is to say that this hypertention is first time detected and PT`s had no such past history"

this is wreetin letter give me to dr kanu bhai parmar " janvi narsing home" gurukul char rasta waghodia road vadodara. so plz sir my claim amt paased early as possible 31, 079/-

Below is the e-mail chain that i have initiated from my end to your team with absolutely no response.
[protected][protected][protected][protected]------
adilla vivek
5:58 PM (8 minutes ago)
to corporateresponse, shivananda.mahadeviah

Hi Team,

Please have the courtesy to at least acknowledge the e-mail that i have been sending.

Thanks,
Vivek Adilla

On Sat, Aug 4, 2018 at 2:54 PM adilla vivek wrote:
Hi,

My name is Vivek, I hold a individual policy numbered [protected]P[protected].

I raised a reimbursement claim numbered 16776850 on 9/4/2018 for Rs 177559 thru the Medi assist office Begumpet, Hyderabad.

Subsequently I was told to submit policy copy and medical reports on 2/5/2018 for which I submitted the documents on 8/5/2018.

I received another mail to submit
Require discharge summaries with investigations pertaining to pulmonary thromboembolism treated 2 yrs prior along with treatment given for COPD.
Require all previous consultation papers.
On 20/6/2018 for which I submitted the documents on 25/6/2018. In this mail sent on 20/6/2018 it was mentioned that the claim will be closed in 10 days if documents are not submitted, but I submitted the documents on 25/6/2018 well before the 10 day deadline.

Then I receive a message on my mobile on 22/6/2018 that the claim has been closed due to non submission of documents just 2 days after the mail was sent from your end.

I enquired with the team in Hyderabad as to how the claim can be closed before the 10 day window expires and they told me that the status is just a temporary and will be reopened as I had submitted the required documents. I was told that it will take 20 days for the claim to be processed, which I took it at face value.

I checked the status of the claim in the first week of July and found that the claim status was still closed, so I visited your Begumpet, Hyderabad office to know what is going on. An associate after going thru the details assured me that the claim will be processed and it will take another 20 days which I unfortunately agreed to.

I checked the status today i.e 4/8/2018 and the status was still closed. I visited your Hyderabad office again and now I am being told to contact the customer care and Bangalore office as this claim is closed. I was told to drop an e-mail to one shivananda mahadeviah to reopen the claim, this is unacceptable. Why should I go around pillar and post to get the claim reopened when the problem is from your end.

Consider this e-mail as a official complaint and take necessary action with regards to the claim.

If the claim cannot be reopened or processed then I would require an official communication in writing as to the reasons for the same, with which I can proceed with other alternative forums for redressal.

Thanks,
Vivek Adilla
[protected]

I Jagdish Chander Bansal Claim no. -. 96687821 not received claim on the basis o[censored]nlogical ground.
I send all documents three times but they still show requirements.
Two months passed to my accident but still I waiting for claim.
Very bad service is provided by customer care officials.
Very bad service by Medi assist India.
Medi ID - [protected]

In an emergency situation i was put in narayan hrudalaya hospital, bangalore. The cashless claim was submitted from hospital after couple of days of my hospitalization date. Mediassist and hospital keep exchanging notes even after the discharge date which put mysef (When i was treated in icu) big trouble. The hospital in their records updated me as released hence no bed, no food, no medicational treatment was provissioned after the discharge time, where as medi assist never paid them hence they did not discharged me practically either. After discussion with company hr, i had to pay the full amount to come out of such troublesome situation. Now mediassist is asking for some papers named icp which supposed to provide by the hospital. By the way hospital is one of their networked hospital. As hospital has not provided me the paper, mediassist declining even to consider the claim as that paper is mandatory. My question to mediassist how patient will get a paper which network hospital supposed to provide. When i tried to reach out to mediassist management, on every occasion i was put on hold and mediassist call center team ensured the call to be terminated after few minute wait.

This is regarding maid # [protected] and claim no.: 17563501 and tracking # h[protected] for my father s k jain.

Please note claim is in in progress status for last 45 days and inspite of all documents received. I have calledn mediassist many time and always told it will be approved in short time. I have also sent emails (Tracking #4647143) there is no response after acknowledge of email inspiste of multiple reminders.

Esclating issue as a next step to you.

Rohit jain
Contact numer: [protected]