Medi Assist India Complaints & Reviews

Hi Sir/Madam

I have an insurance of National insurance Company for my father. The TPA for this is Mediassist. He is suffering from throat cancer and had undergone radiotherapy. After few months of radiotherapy he became very weak and needed supportive care and further investigation and treatment plan for surgery. We applied for cashless facility but Mediassist denied with a sentence that "denial of cashless is not the denial of treatment, you can apply for reimbursement" . When we applied for reimbursement after his discharge then they denied for approval saying that it is not in their policy. Although it is clearly mentioned that if hospitalization is for more than 24 hours and disease is from the listed ones it will be covered.My claim number with Mediassist is 17316439 . Kindly investigate the case and help as soon as possible.

I have applied for the medical claim regarding my sudden chest pain .So, In emergency I was admitted in the hospital in hurry and when I become stable I did the further process of admission in hospital so the hospital management print the admitting time when I paid the deposit amount which is much later than the actual time and in case of discharge also there are certain process you have to apply for discharge first so time of leaving the hospital is differ from the actual time ..And the hospital charge is too much for one day they charge 11k and suppose if I will continue there the 2nd 2nd day they will charge again 20k .And I don't have that much salary to afford that .Already due to this incident I took loan from my friend ...So please show mercy on me and do reimbursement as I don't have much salary .if I will have the salary then I will try to stay for 2-3 days

I have submitted a partial reimbursement claim for maternity of my wife. Medi Assist has denied both pre-hospitalization claim and post-hospitalization claim .
They also denied new born baby bill stating that hospital admission is not clear. I fail to understand how can it be not clear in case of maternity.
If the claim has to be denied on the face of it then why did Medi Assist kept on asking me for so many documents and so many documents were asked for many times.
No satisfactory reply for denial has been given.

Sir,
I have submitted a claim (Claim no[protected] for my daughter in medi assist for inguinal hernia.
As per the discharge papers of the baby given by hospital it was not present at the time of birth hence it is not a congenital disease/defect, also the opd notes of the hospital where baby got operated states that it is not congenital in nature.
Secondly even if we take this as a mistake from hospitals n go by the insurance company rules congenital external surgery is not covered under the claim but this surgery was inguinal hernia which is an internal surgery.
Hence claim should be processed or else we have to seek for other ways.
Regards
Priyanka kanjikar

R/sir
I'm regular payee person of the oriental insurance company for the last many years which you are totally.
On 30may2018 i was admitted my wife due to electric shock in d. S hospital mathura. And after this i sent all the required documents for settled the claim to mediassists which reached you on 06/02018. Till now claim is not settled. Ni information regarding this i am getting. It us impossible to talk you with toll free number[protected]. Plz help me to settle the claim.
Chandrapal sharma
Policy no.272800/48/2018/1752
Claims no. 17151451
Pt. Name krishna sharma
D. S. Hospital mathura
Date of hospital.30/05/2018
Discharge date 02/06/2018

I am the employee of mnc company. My son was admitted for the 5 days in the month of may 2018 and the hospital was out of mumbai. I asked the agent what documents required for claim and i brought all the documents from there which he was listed. The original documents submitted are as below,
1) final bill (Having stamp of the hospital with the signature of the doctor)
2) discharge card (Having details of why he was admitted and what the doctor did the treatment.)
3) all medical bills and pathology original bills)
After submitting all the documents the medi assist mailed me that they required others documents too which was not informed me before.
And the documents are as below,
1) kindly provide original investigation reports which has been charged in this said claim — which i have and submitted to the agent
2) indoor case papers (Icp) - attested copy kindly provide icps — which doctor does not have currently because i have not given him any requirement while at the time of hospitalization
3) kindly provide original final receipt of rs-7500 of final hospital bill - which was submitted before but now they are asking me printed receipt.
So if i will not able to submit the documents then they won't process my claim.
Its a very false requirement from the medi assist to avoid the payment of claim amount.
2 years back when i have submitted my wife maternity claim to the medi assist then they wasn't ask me anything additional documents.
I want to get the claim settled properly without any further deviations and misconduct and frauds.
Kindly close the issue asap.

Regards,
Chetan bhamare

Dear sir,

Policy holder name: kishorbhai shantilal dave
Policy number:[protected]
Claim number is 16556891

We are regular premium payer with my all of family last 2 year or more.
As per above claim number we are submitted all necessary document as per rules & regulation to medi assist office in vadodara on month of march-2018. Insurance team rejected claim without any reason. We meted vadodara local team & explain all subject, they suggest you can get your claim. As per local team suggest we submit more document & avoidance for same. But still we have not received payment.
We are belong to middle class family, and suffering with hospitality, financial crisis. So i hope you understand your customer situation.
Kindly request to you same do need full as possible as
Please let me know if any more information required.

Thanks & regards
Kevin dave
[protected]

I am cognizant employee and i am going to admit columbia asia hospital for gallbladder operation and estimation amount is near about 92k. After aplying i received an approved amount of 40k.
Now none of the mediassist person are able to clarify the amount on what basis i am getting this much amount.
After waiting for long time they are picking up phone or some times that also not occuring.
In our official portal it's mentioned if the amount is below 1lakh then medibuddy will pay the full amount. But after that i came to know all will be calculated based on bed charge.
If bed charge is 2500 all the amount will vary based on that charge.
Now one medi assist employee is telling within 2500 bed, doctors charge for one day all will be included.
So what's the actual calculation.
All the medibuddy employee are not having any knowledge but they are serving people.
I want proper justification on what basis i am getting the amount.

I would like to escalate the below claim for my father who passed away on 9 dec 2017 and i had requested for his claim of ~inr 72, 000 in the month of mar'18.

It has been more than 3 months i have been chasing with response as "in process", can you update me how long does this take to process a claim???

It has been one of the worst experience considering the situation am going through. How can such a reputed company have pathetic customer service response / processing time.

I have been calling your customer service toll free every week since 3 months. Please have some mercy and get this claim approved as this is much needed for my mother who is in financial crisis.

Maid: [protected]

I am unable to get status of my submitted claim. I am trying to get the status and update over it but unfortunately unable to get it through either message or online.
After confirmation with meddiasist team i submitted the claim reimbursement documents to meddiassist executive by hand on 11th/12th april 2018. After which i got the acknowledge message from meddiassist team that they have recieved the claim documents on 17th april 2018 at 11:41 am by mentioning reference number only which is p[protected].

As i am unable to login to the portal (Which is already highlighted top meddiassist team by sending emails) and i dont have even claim number, i am unable to track my claim status. I tried to contact meddiassist team over tollfree number and they mentioned they are unable to see any request over there. Kindly help me to get the status of the claim

Subject about delayed in payment and no response from your tpa mediassist india ltd
Harshadkumar shambhubhai patel was operated auxiliary narcotic caseated axillaries lymph node level 1and leval2 wide excision. On 19/05/2018
With claim id: 17014600
Claim amount: rs.27398/-
Approved amount: rs.23980/-
Till today i had note received any amount from tpa kindly do needful
Patient name : harshadkumar shambhubhai patel ip no. :
Insurance company : the oriental insurance co. Ltd. Policy no. : 142600/48/2018/4497
Medi assist id : [protected] primary beneficiary : harshadkumar shambhubhai patel
Policy holder : mehsana dcmpu ltd employee id : 16004365

My ma-id no. Is [protected] and i had submitted my insurance papers along with other requested documents for a post hospitalization claim on 5th june at the medi assist office in delhi (Bahadur shah zafar marg). It is now 22nd june and i've not received any claim id. The tracker no. Is del00053604. How do i escalate this, it's been 17 days now?

I've called them 4-5 times during this period and the response i get everytime is that claim id will be generated in the next 2 days.

Myself mayur ramchandra yallurkar, with policy number[protected] have claimed for a bill for the first time with claim number. 96211462.
I was asked to submit additional documents for the same.
I have submitted all required additional documents as per their requirement on 15 th june 2018 by post.
Till today i have not received any update on my claim number nor got any message from mediassist.
I request you to do the needful immediately and serve us better.

I want to exclude my parents from the insurance policy and despite sending multiple emails before the renewal period (June 2018), medi-assist is unwilling to exclude my parents from the policy. They are deducting the amount from my salary account.

I demand a cancellation of the policy and a refund of the amount deducted.

Emp id: 750506 (Oracle)

Hi,

I have submitted a claim and all documents which i got from hospital already submitted and still process has not been completed.

Mediclaim guy asked some more documents. I asked same from hospital and they are not able to provide that. They told this is not my issue. Handle your issue with your own (They told they are providing this much documents to all patients and their medi claim processed without issue).

Could you please help here to process this? Or else please suggest how to get my money back (14000/-).

Meidassist guy is simply trying not to process this.

16726511 under policy# 11910245_topup (Emp no[protected]Lti);emp name - diwakar kumar[protected]

Thanks,
Diwakar
[protected]

My husband underwent treatment for lumbar spondylitis problem at ksac ayurveda hospital, koramangala, bangalore. I submitted all the relevant documents for reimbursement from mediassist for the amount 197, 019. But the claim was settled for only 84, 258 (Which included only inpatient charges, medicines and other miscellaneous charges). But the actual treatment charges are not reimbursed. I even submitted the papercutting of the government approval for ayurvedic treatment. Government already declared that ayurvedic treatment should be covered under health insurances. I submitted all the relevant documents still this claim is not processed fully.
I got that partial amount also after so much struggle, after numerous followups in december 2017. Claim is submitted in may 2017.
I already followed up for the remaining amount but they responded only 84258 is the final amount. I lost 112761/- in this claim. This is not at all acceptable and not serving the purpose of insurance policies. As per government when ayurveda treatment is covered under all health insurance policies why is mediassist not supporting this.
As per the comment from mediassist"expenses on abhyangam rs.14000/-, elakhizhi rs.19600/-, sarvangadhara rs.40000/-, mamsarohini rs.10000/-, navarakhizhi rs.10000/-, bone setting rs.9800/-, total of all these i. E rs. 103400/- which would fall under massage, dhara and alike procedures that are excluded from the scope of the policy are not payable"

The above procedures are the actual treatment which are suggested by that doctors. The above answer doesn't make sense that comes under massage.
Ayurvedic treatment itself is massage treatment and i am not convinced with the solution provided.

Please kindly look into this issue and help in getting the full amount reimbursed. I am ready to file complaint in consumer court if i am not getting justice.

I have a medi-claim policy at your end bearing no.[protected]. I have applied for a reimbursement of my medical expenses for different medical examination on 22.12.2017. May claim no. Is 15983784. Now, after that, you have asked me to submit some documents. The same documents have been submitted on 08.03.2018. But till date no amount has been reimbursed in my account.
So, this is only a claim for medical examination. More than five months has been over, but till date i have not got the reimbursed amount. So, for actual claim during hospitalization, i think i will not get any amount.
This type of incidents not at all expected from your end. As such you are requested to look into the matter so that the matter should be resolved immediately.

Sir,
I have applied for mediclaim after operation dated 12/05/17 and submitted all the documents for necessary action but the payment is not released yet. This is really very pathetic from the reputed company like you not passing my claimed. Iam mentally harrased by this. I request to release my claim
Claim no[protected]
Name-nidhi shukla
[protected]

Hi team,

My complain is regarding the claim#15999456

My mother was admitted to hospital on cashless scheme.
The final bill was of 473001 /- rs, out of which rs.205542/- got approved by mediassist. Rest i paid and left for home.

As per policy normally 80% should be paid by mediassist 20% by patient side, but in my case i paid more than 60% of the bill, so i have gone through the bill in detail,

In the non payable section, there are few things which i understood like excess icu charges, surplus bed charges.. Etc but there is an term "weighted average" which is of 79, 162 /- rs.
I have asked for its clarification multiple times but didn't got response in detail.

Second important thing apart from my base policy, i have taken the addition cover of 2 lakh rupees, which they forgot to consider at time of final bill.
So post discharge i got a message from mediassist that additional 34000/- got approved against your bill.
As i already paid the bill to hospital according to the previous approval amount.
Ideally i 'll be getting that money in my account, for that i have submitted all the papers to them but after 3-4 months they denied to pay, saying everything is covered in cashless.

Pfb required details:
Empid : 592395
Maid : [protected]

Patient name: dulari devi (Mother)
Maid : [protected]

Thanks

Reg : pa[protected] ; letter type dl; virinchi hospitals

This is extremely disappointing to know that this cashless request from hospital has been denied though i verified with medi assist associates about this clash claim process eligibility of the same.

3 to 4 weeks back, i spoke with one of mediassist team and showed my parents mediassist cards and based on his advice to go for cashless claim request as i am eligible to claim the same. Then, i went ahead and fixed doctor appointment, surgery has been planned this friday morning and spent 10, 000rs for pre-surgical procedures which were completed on last saturday.

This is very disheartening to know that this request has been denied saying that i need to wait till 1st nov’18 to plan for this surgery claim. If this was the case, your team could have informed me during my initial enquiry so that i could have planned it in nov’18.

I sincerely request you to re-consider this request and help my mother to undergo surgery through cashless claim this friday morning.

Kindly, respond with your exception approval for the following reasons :

• i am moving to onsite in next 2 weeks’ time
• spent 12000rs already for all pre-surgical procedures
• difficult to get surgeon’s time
• lot of internal emotional feelings with in family.